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Home My WebLink About12-21-07 -I 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 6 File Number o 8 6 0 Date of Birth 19516 561 6 o 8 1 7 2 0 0 6 o 105 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name S WID E R SKY EON A MI F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Soh. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FILL IN APPROPRIATE OVALS BELOW 00 1. Original Return o 4. Limited Estate o o 2. Supplemental Return o o 1 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes R . MAR K THOMAS, ESQUIRE 717 796 210 0 Firm Name (If Applicable) REGISTE ~ ~~ILLS US~L Y .-,.J CJ 'I~! 1'1 - n N Second line of address -c ~ First line of address 101 SOUTH MARKET STREET City or Post Office State ZIP Code C) M E C H A N I C S BUR G P A 17055 Correspondent's e-mail address:rmtesQ@deiazzd.com Under penalties of pe~ury, I declare that I hav examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, ct and complete. Declaratio reparer other than the personal representative is based on all information of which preparer has any knowledge. SIG OF PE N RESPON E FO LI ETURN DATE -~-p Mechanicsbur PA 17055 DATE Market Street Mechanicsburg PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 L 15056041125 15056041125 -I -.J 15056042126 REV-1500 EX Decedent's Name: EDNA F. SWIDERSKY RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 231328.80 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ o . 0 0 15. 16. Amount of Line 14 taxable 2 3 1 3 2 8 . 8 0 at lineal rate X .04L., 16. 17. Amount of Line 14 taxable o . 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable o . 0 0 at collateral rate X .15 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 195165616 229000.00 27176.38 2 5 6 1 7 6. 3 8 1 9 7 0 2. 1 2 5 1 4 5. 4 6 2 4 8 4 7 . 5 8 2 3 1 3 2 8. 8 0 o. 0 0 10409.80 O. 0 0 O. 0 0 10409.80 D 15056042126 -.J REV-t500 EX PlIge 3 Decedent's Complete Address: File Number 21 06 0860 DECEDENTS NAME EDNA F. SWIDERSKY STREET ADDRESS 320 North Market Street CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 10,409.80 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 496.98 Total Interest/Penalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 496.98 0.00 10,906.78 A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 10,906.78 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (Ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX +' (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER EDNA F. SWIDERSKY 21 06 0860 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real DroDertv which is iointtv-owned with riaht of survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1. 2. DESCRIPTION ~20 North Market Street, Mechanicsburg, PA 17055 4 bedroom, 2 story home with full basement; gross above grade living area is 1336 square feet- ~ee attached appraisal) fJacant lot adjacent to 320 North Market Street, Mechanicsburg, PA, with property address of ~ Portland Street, Mechanicsburg, PA. Size. 0.1635 acres (see attached appraisal) VALUE AT DATE OF DEATH 155,000.00 74,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 229 000.00 REV-1508 EX';' (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDNA F. SWIDERSKY FILE NUMBER 21 06 0860 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. VALUE AT DATE OF DEATH 22,999.76 2. 3,543.18 3. 500.00 4. :apitol Blue Cross (insurance refund) 133.44 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional shee1s of the same size) 27 176.38 RE\l'-1511 EX-I- (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDNA F. SWIDERSKY SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ITEM NUMBER A. 1. 2. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 21 06 0860 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Malpezzi Funeral Home Funeral dinner - Hoss' Restaurant 880.90 436.52 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (5) Thomas James Swidersky Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 601 Freedom Road 10,680.00 City Mechanicsburg Year(s) Commission Paid: 2007 State PA Zip 17055 Attorney Fees R. Mark Thomas, Esquire Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant 1,500.00 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees 313.00 Accountanfs Fees Tax Retum Prepare!'s Fees Betty Seidle (2006 taxes) 85.00 Mark E. Hilbert and Associates (real estate appraisals) Barry Heckard, Tax Collector (real estate taxes) John Swidersky (plumbing repairs to home) United Water (water charges from October 2006 through November 2007) Mechanicsburg Borough (sewer charges from October 2006 through August 2007) Keystone Oil (fuel oil from November 2006 through July 2007) Foremost Insurance (homeowners insurance premium for 2006 and 2007) Brian Wevadau (lawn care service) Postage 475.00 2,149.87 475.00 520.98 312.40 795.35 702.50 360.00 15.60 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 19.702.12 REV-1512 EX + (12-03) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDNA F. SWIDERSKY FILE NUMBER 21 06 0860 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~Iaremont Nursing and Rehabilitation Center (final nursing home bill) 4.584.50 000 Claremont Road Carlisle, PA 17013 2. ~omcast 47.82 3. Jnited Water 129.51 4. Verizon 107.71 5. :lp& L 275.92 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5 145.46 ,"'-"" "'. ". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDNA F SWIDERSKY SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Linda L. Wevadau DAUGHTER 0.25 1014 East Coover Street Mechanicsburg, PA 17055 2. John M. Swidersky . SON, 0.25 320 North Market Street Mechanicsburg, PA 17055 3. Donald N. Swidersky 0.25 Park Hills Drive SON Mechanicsburg, PA 17055 4. Thomas J. Swidersky 0.25 601 Freedom Road SON Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ FILE NUMBER 21 06 0860 (If more space is needed, insert additional sheets of the same size) >-..:-- ..- l-AW O""'ICES IN F. L..AFAVER , THIRD STREET i CUMBERI.AND. PA. LAW OFFICES JON F. LA-FAVER ,rF\ 317 THIRD STREET 0' \~ ; - ' NEW CUMBERLAND, PENNSYLVANIA 17070 ; LAST WTIL AND 'lESTAMENT OF EI:NA F. SWIDERSKY I, EmA F. SWIDERSKY, of Mechanicsburg Borough, Cumberland County, " H iiPennsylvania, being of sound mind, mennry and tm.derstanding, do hereby make, !!publiSh and declare this as and for my Last t.lill and Testament hereby revoking :1 H :jand making void any and all other wills by me at any time heretofore made. i, ~ I. iI ij I direct that my Executor hereinafter named shall pay all my just :j !;debts and ftmeral expenses as soon as conveniently may be done after my decease. .! H Ii II. ,I :1 :i All the rest, residue and remainder of my estate, whether real, ii !!personal or mixed, and wheresoever situate, I hereby give, devise and bequeath \mto my husband, NORMAN SWIDERSKY, if he survives me by a period of thirty days. " j ~ JiIf my said husband does not survive me by a period of thirty days, then this " ~ I :Igift to him shall be divested and I then give, devise and bequeath my entire ....'J 'I. e ;iesqti~ as follows: 6 II ~~::.: ~i='.c. 1'" - :,-_'-'-:J't_<, ;", fZ"~' _ -.;,..:~ ~ :, .:: ~_.'--:,). :.-:.:.. CJ"I i : '~!I ar;- !-!-1,'; t-~-- ...:.~:: (../)lj 0:5 ,-"=,,,J (,) c.,.:1t =1 ~i :1 'i H " l' !I A. One-fourth (1/4) tmto my daughter, LINDA L. WEVODA.U. One-fourth (1/4) tmto my son, JOHN M. SWIDERSKY. B. c. One-fourth (1/4) tmto my son, 'lliOMAS J. StIDERSKY. One-fourth (1/4) tmto my son, IDNALD N. SWIDERSKY. D. III. . i I hereby nominate, const~tute and appoint my husband, IDRMAN SWIDERSKY, j lias Executor of this, my Last Will and TestanEnt. If the said Nonnan Swidersky ishould predecease me, fail to qualify or cease to act as such, then I nominate, constitute and appoint my son, IHOMAS J. SWIDERSKY, as Executor. Page one of t:v.;o Pages Dl. No fiduciary acting 1ID.der this Will shall be required to 'post bond , ::in this J'urisdiction or in any jurisdiction in which he may act. " H ': \1 11 Ii :jthis, " IN WI'lNESS WHEREOF, I, EDNA F. SWIDERSKY, the Testatrix, have 1ID.to IIlJ Last Will and Testammt, set my hand and seal this S -0..... day of ~~nS I. 'I , A. D., 1983. H ii il :! 'i a.~:p. ~~~) ~ 1 "\ " 1; r :i II :iabove-na:rred Testatrix, as and for her Last Will and Testament, in the presence SIGNED, SEAIED, PUBLISHED and DECLARED by EmA F. SWIDERSKY, the i ,iof us who have heretm.to subscribed our na:n:es as witnesses at her request, in ithe presence of the said Testatrix and of each other. ;! t2 /1 j.~~/ +,') , I (j // P,'AA~t:) if '--- ' ,~ /1 r.6!e/_. ~AW OI"P"CES JON F. LAFAVER 317 THIRD STREET ~E.W CUMBER1..AND, PA. Page two of two Pages Mark E. Hilbert & Associates 07-209 File No. 07-209 SUll1mery Appraisal Thomas Swidersky 60 1 r: reed om Road Mecl1anicsburg, PA. 17055 File r'-Jumber: 07-209 SUlllmery Appraisal Report In <l ccordance with your request, I have appraised the real property at: 320 North Market Street Mechanicsburg, PA 17055 TI1 e purpose of this appraisal is to develop an opinion of the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In illY opinion, the market value of the property as of August 17, 2006 is: $155,000 One Hundred Fifty-Five Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, fin;11 opinion of value, descriptive photographs, limiting conditions and appropriate certifications. 1~~ Mark E. Hilbert MARK E. HILBERT & ASSOCIATES 3607 Rosemount Ave, Camp Hill, Pa 17011 Thi;; Clppraisal is to provide the owner with Fair market value 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 ,.' Mark E. Hilbert & Associates 07-212-A File No. 07-212-A Summery Appraisal Thomas Swidersky 601 Freedom Road Mechanicsburg, PA 17055 File Number: 07-212-A Summery Appraisal Report In accordance with your request, I have appraised the real property at: 4 Portland Street Mechanicsburg, PA 17055 The purpose of this appraisal is to develop an opinion of the market value of the subject property, as vacant. The property rights appraised are the fee simple interest in the site. In my opinion, the market value of the property as of August 17, 2006 is: $74,000 Seventy-Four Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, limiting conditions and appropriate certifications. Date of Death August 17, 2006 ,~~ Mark E. Hilbert MARK E. HILBERT & ASSOCIATES 3607 Rosemount Ave, Camp Hill, Pa 17011 This appraisal is to provide the Estate with a Fair market value ..- 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 (717)697-4696 September 16, 2006 Thomas J. Swidersky 60 I Freedom Road Mechanicsburg, PA 17055 The Funeral Service for Edna Florence Swidersky We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHIu"lDISE TriAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff. . . . . . . FUNERAL HOME SERVICE CHARGES SELECTED MERCHANDISE: $3865.00 $3865.00 Renaissance Rose Stainless. . 10 Ga. Galvanized Steel. . . . Register, Memorial Cards, Adm. . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . $9833.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADV ANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES $4100.00 $1800.00 $68.00 CONTRACT PRiCE HISTORY 09/05/2006 Cumbo Co. VA. . 09/05/2006 Forethought. . . 09/16/2006 Pre Need write off . TOTAL AMOUNT DUE $725.00 $120.00 $287.20~ /.6~:{"'....) $68.00 .,&. $143.40 ~ $100.00 '" $60.00 1- 't /) $217.30 '!- $125.00 ~ $1845.90 $11678.90 Opening Grave, . . . . Cemetery Equipment. . . Newspaper Notices - Local . Newspaper Notices - Out-of-town . Newspaper Notices - Sentinel . . Clergy/Mass Offering, . . . . Certified Copies of the Death Certificate . Flowers. . . . . . . . . . . Monument Engraving, . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES. $-100.00 $-10555.77 $-142.23 $880.90 ll.- l- e i ~lo Job 1 q\v l--u3)~ Banquet Mechanicsburu 61 Gettysburg Pike Mechanicsburg, PA 17055 717-697-2214 W~IW . hoss~ , l: lilli '21 !2()l!6 Se r: ,ct I Blie M LneCK ~~1LO~ Seat 1 1 Chicken Breast Unsweetened Iced Tea Seat 1 total:[ Seat 2 1 Chicken Breast Slerra t4ist Seat 2 Seat 3 1 Sir 10 Hi T 1 P5 Pepsi Sedt 3 Seat 4 1 Kld's Pizza Dr, Pepper Seat 4 ~)t:j l j 1 K1J'S Grl11ed Cheese Pepsi Seat 5 1 :31 :05 Pt.j laDle 41 7.99 1. 59 10 .15J 7.98 1 . 5~J total:[ 10.151 7.99 1. 5~ total: [ 10.151 J.J~ 0,98 total:[ 5.28] 3.99 0.99 toto1:[ 5.28J Seat 6 1 Ground Beef Unsi'Jeetened Iced Tea Seat 6 total:[ Seat 7 1 Shnmp App. Sr 1 Carver Ham Pepsi Seat 7 ( .:J9 1.59 10.15] 2.99 9.9B 1. 59 total:[ 15.44] Seat 8 1 Adult Salad Bar Unsweetened Iced Tea Seat 8 tota1:[ 5.99 1.59 8.03J Seat 9 1 Ground Beef Unsweetened Iced Tea Seat fl t I ,I 1~.11 It! 1 CdlVt:f Turk~y nip T PI-l'" 1 7.99 1. 59 )'J ;t" .11 It J I Carver Tu(key Diet Pepsl ;jeat 10 I:' ','J tot Ii I: l 11.2/ J Seat 11 1 Meatloaf Pink Lemonade Seat 11 8.99 1.58 total:[ 11./i i Seat 12 1 Adult Salad Bal 5.99 ~JJa te r Seat 12 LdtJ I: [ 6 ~;el1 t 1J 1 Adult ';alad Bal 589 i1at~1 Seat 13 total:[ 6.35) Seat 14 1 Salad Bar w/Sand 5.99 1/3 Pound Burg Sal " ;1'1 Add Frles Coffee I. L:J Seat 14 total:[ 8.JU) . Seat 15 1 Adult Salad ~di ~ 99 Un5,~ee t enetl !' ';;1 Lj Seat II' . I Sea t 16 i ChIcken lenders '7.89 vJater Seat 16 total:[ 8.4'7] Seat i 7 1 Adult Salad Bar Uns\~eetened Iced Tea ;jeat 17 total:[ ') 99 1.59 8. Cn] Seat 18 1 Ch i cken T enc1ers Pink Lemonade Sea t 1U 1.99 1.59 total: [ 10.15] Seat 19 1 Meatloaf 8.99 Unsweetened Iced Tea 1.59 Seat 19 total:[ 11.21] Seat 20 1 Stuffed Chicken Breast Unsweetened Iced Tea .eat 20 tota 1 : [ 9.99 1.59 12.27] Seat 21 1 Salad Bar w/Sand Philly Steak Sal Pepsi Seat 21 tutol:[ 5.99 0.99 1.59 J ;:(jJ Seat 22 1 Chicken Cordon Bleu Hi ~y Seat 22 1 Chicken Cordon Bleu Diet Pepsi Seat 22 1O.9~ 1.59 total:[ 13.33] "II t 23 1 Tilapia Pepsi Seat 23 7.99 1.5!:l total:[ 10.15] Seat 24 1 Sirloin Tips 7.99 Unsweetened Iced Tea 1.59 Seat 21 total:[ 10.15] Seat 25 1 Shrimp (br/scampl) Pepsi Seat 25 10 .99 1.59 total:[ 13.33] Seat 26 I Meatloaf 8.99 lJns~')etO t enect f ced Tea 1 .59 Seat Lb tota1:[ 11.21] Seat 27 1 Kid's Hot Dog Unsweetened Iced TEa Seat 27 total:[ Seat 28 1 Flat Iron Steak Unsweetened Iced Tea Seat 28 total:[ 3.99 0.99 5.28] 11.99 1.59 14.39] Seat 29 1 Sirloin TIps 7.99 Sweetened Iced Tea 1.59 Seat 29 total:[ 10.15) Seat 30 1 Adli lt Sa 1 ad Ba r Un. t 'i 't~d feed Tea Seat tota 1: [ Seat 31 1 Salad Bar w/Sand Philly Steak Sal UI; ;:~t:t~l1ed Iced Tea Seat ;: tota 1 : [ 5.9!:J 1.59 8.03] 5.99 0.99 1.5:) 9.08] Seat 32 1 Salad Bar wlSand 5.99 Phi lly Steak Sa 1 0.99 Pepsi 1.59 Seat 32 tota 1 : [ 9.08] Seat 33 1 Adult Salad Bar 5.99 Pepsi \.59 Seat 33 total:( 8.n3] Seat 34 1 Adult Salad Bar 5.99 Pepsi 1.59 Seat 34 total:[ 8.03] Seat 35 1 Sir 1 0 inTi ps Mug Root Beer Seat 35 7.99 1.59 total:[ 10.15] Seat 36 1 Sirloin Tips 7.99 Unsweetened Iced Tea 1.59 Seat 36 tota 1: [ 10.15] Seat 37 1 Kid's Cheeseburger Diet Pepsi Seat 37 3.99 0.99 total:[ 5.28] Seat 38 1 Kid's Chicken Tenders 4.~9 Mt. Dew 0.99 1 Chicken Breast 7.99 Unsweetened Iced Tea 1.59 Seat 38 total:[ 16.49] SubTotal Tax Gratulty lota1 TIP 349.00 20.94 66.58 ~jO,~L TOTAL ~__. ._ _ Visa - 43b.52 Acct:XXXXXXXX7 31 AuthCode: 167312 **********[~~IOMt~ [OP~*********** T e 11 us hO~J we are do 1I1Q You could win a free meal A 2 mlnute ctutulfldted survey Call 1-600-974-2524 Entel- access code 697 50th Callers win $10 Gift Carel 1111111111111111111111111111111111111111 * 5 0 1 2 6 5 * I U RECEIPT FOR PAYMENT ----------------~-- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17G13 Receipt Date: Receipt Time: Receipt No. : 9/29/2006 10:10:10 1045831 SWIDERSKY EDNA F Estate File No. : Paid By Remarks: 2006-00860 THOMAS JAMES SWIDERSKY JA ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE JCP FEE Check# 7579 Total Received......... 260.00 15.00 5.00 4.00 10.00 ---------------- $294.00 $294.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17G13 Rece~pt Date: Rece~pt Time: Recelpt No.: 8/09/2007 14:19:25 1049477 SWIDERSKY EDNA F Estate File No. : Paid By Remarks: 2006-00860 R MARK THOMAS CJ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 4.00 ---------------- Check# 1516 $4.00 Total Received......... $4.00 CUMBERLAND COUNTY GENERAL FUN f '""" .. --"-~.'. ......"..,... (]1 --..J I\) ...... C- o :::::J CD (J) ~ :::::J :c o 11l a. I 11l ~ ~ 00' C" C ~ to ~ 'TJOJm~ CD tu 'TJ x CD tu 'TJ 'TJ "'U:JCDCD 'X~ ~. g CD CD "'-.." c.. 0 . ~'\\" ffi .... '.'''-.... "'~ --..J ...... ...... I\) ~. ,...,.,.~:-- . -,..?_.~~Y",~~... . ....~ t t ~ ~ i .x::J ~9" - r>~ ~ ;....-" ~ O~ - - 0'6" " " o m I ~ j Cf'1 ~~l C1I ~ I <y.p i .-";".- j '/1 ! f t ~-j Mark E. Hilbert & Associates 07-209 File No. 07-209 ********* INVOICE ********* File Number: 07-209 September 28,2007 Thol1las Swidersky 60i Freedom Road Mecl1anicsburg, PA. 17055 Borrower: Edna F. Swidersky Estate Invoice # : Order Date : Reference/C ase # : PO Number: 07-209 September 25,2007 07 -209 32(1 North Market Street Mecl1anicsburg, PA 17055 Appraisal $ $ 300.00 Amount Due $ $ ($ ($ --..-..-----..--- $ 300.00 300.00 0.00 ) ) Invoice Total State Sales Tax @ Deposit Deposit Terms: Balance due upon receiptof invoice Ple;lse Make Check Payable To: Mml E. Hilbert & Associates 3Gi I 7 Rosemount Avenue, Suite 405 CCll11p Hill, PA 17011 Feci. 1.0. #: 23-2391423 TO INSURE PRPOER CREDIT PLEASE RETURN A COPY OF THIS INVOICE WITH YOUR PAYMENT. " 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 Mark E. Hilbert & Associates 07-212-A FileNo.07-212-A ********* INVOICE ********* File Number: 07-212-A August 17,2007 Thomas Swidersky 601 Freedom Raod Mechanicsburg, PA 17055 Borrower: Edna F. Swidersky Estate Invoice # : Order Date: Reference/C ase # : PO Number: 07-212-A September 25,2007 07-212-A 4 Portland Street Mechanicsburg, PA 17055 Appraisal $ $ 175.00 Invoice Total State Sales Tax @ Deposit Deposit $ $ ($ ($ 175.00 0.00 ) ) Amount Due $ 175.00 Terms: Balance due upon receiptof invoice Please Make Check Payable To: Mark E. Hilbert & Associatss 3607 Rosemount Avenue, Suite 405 . Camp Hill, PA 17011 Fed. 1.0. #: 23-2391423 TO INSURE PRPOER CREDIT PLEASE RETURN A COPY OF THIS INVOICE WITH YOUR PAYMENT. ," 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 ............................................................................................................................................................................................................................................................................................................ MAKE CHECKS PAYABLE TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 RETURN SERVICE REQUESTED MECHANICSBURG SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT FOR FINAL INSTALLMENT BILL #: 559 PROPERTY LOCATION 04 E PORTLAND STREET LAND LESS THAN 1 ACRE vacant Land SWIDERSKY, NORMAN & EDNA F 320 NORTH MARKET STREET MECHANICSBURG, PA 17055 o W N E R Please indicate: a FINAL INSTALLMENT 0 FINAL INSTALLMENT WITH PENALTY CASH CHECK # AMOUNT $ MAIL TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 1'11111.1111111111.1..1.1.1 l\v~\~' "\ \ \~ FINAL INSTALU~ENT NO DISCOUNT If Paid On or Before 10/31/07 N/A If PlIld After 10/31/07 N/A ............................................................................................................................................................................................................................................................................................................ MAKE CHECKS PAYABLE TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 RETURN SERVICE REQUESTED MECHANICSBURG SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE BILL #: 559 RETURN THIS PORTION WITH PAYMENT FOR SECOND INSTALLMENT PROPERTY LOCATION 04 E PORTLAND STREET LAND LESS THAN 1 ACRE Vacant Land SWIDERSKY, NORMAN & EDNA F 320 NORTH MARKET STREET MECHANICSBURG, PA 17055 o W N E R Please indicate: a 2ND INSTALLMENT :J 2ND INSTALLMENT WITH PENALTY MAIL TO: CASH CHECK # AMOUNT $ Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 111I111'1111111111.1..1.1,1 SECOND INSTALLMENT NO DISCOUNT If PaId On or 88fore 9/30/07 N/A If PlIld After 10/31/07 N/A ..........................................................................................................................................................................................................................................................................................................., MAKE CHECKS PAYABLE TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 RETURN SERVICE REQUESTED MECHANICSBURG SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE Please Indicate: a FULL PAYMENT a 1 ST INSTALLMENT BILL #: 559 RETURN THIS PORTION WITH PAYMENT IN THE ENCLOSED RETURN ENVELOPE PROPERTY LOCATION 0 04 E PORTLAND STREET SWIDERSKY, NORMAN & EDNA F W LAND LESS THAN 1 ACRE 320 NORTH MARKET STREET Vacant Land MECHANICSBURG, PA 17055 N E R CASH CHECK # AMOUNT $ MAIL TO: FULL PAYMENT 2% DISCOUNT TO 08131107 FACE PENALTY 09101107 TO 10131/07 11101107 TO 12/31/07 Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 1'11111'1111111..1.1..1.1.1 $322.40 $328.98 $361. 88 OR - If PlIid On or 88fore 8/31/07 N/A I 111111111111 11111 1111111111 111111111 1111111111111111111 I11I 115M- 2244 ............................................................................................................................................................................................................................................................................................................ ~AKE CI:IECKS PAYABLE TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 RETURN SERVICE REQUESTED MECHANICSBURG SCHOOL DISTRICT 2007JD8 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT FOR FINAL INSTAllMENT PROPERTY LOCATION 0320 N MARKET STREET LAND LESS THAN 1 ACRE Residential Building SWIDERSKY, NORMAN & EDNA 320 NORTH MARKET STREET MECHANICSBURG, PA 17055 BILL #: 560 Please indicate: o FINAL INSTALLMENT 0 FINAL INSTALLMENT WITH PENALTY MAIL TO: CASH AMOUNT $ CHECK # Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 1.../1 1'11111.11.1.1..1.1.1 ~\~\ cY ,,\\'" FINAL INSTALU~ENT NO DISCOUNT If Paid On or Before 10/31/07 $430.38 If PaId After 10/31/07 $473.41 o W N E R ........................................................................................................................................................................................n.................................................................................................................. MAKE CHECKS PAYABLE TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 RETURN SERVICE REQUESTED MECHANICSBURG SCHOOL DISTRICT 2007JD8 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT FOR SECOND INSTALLMENT PROPERTY LOCATION 0320 N MARKET STREET LAND LESS THAN 1 ACRE Residential Building BILL #: 560 SWIDERSKY, NORMAN & EDNA 320 NORTH MARKET STREET MECHANICSBURG, PA 17055 Please indicate: o 2ND INSTALLMENT ::l2ND INSTALLMENT WITH PENALTY MAIL TO: CASH CHECK # AMOUNT $ Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 1...1/1'111/1.11.1.1.,1.1.1 SECOND INSTALLMENT NO DISCOUNT If PaId On or Before 9/30/07 $430.38 If Paid After 10/31/07 $473.41 o W N E R ............................................................................................................................................................................................................................................................................................................ MAKE CHECKS PAYABLE TO: Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 RETURN SERVICE REQUESTED MECHANICSBURG SCHOOL DISTRICT 2007JD8 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT IN THE ENCLOSED RETURN ENVELOPE PROPERTY LOCATION 0320 N MARKET STREET LAND LESS THAN 1 ACRE Residential BUilding SWIDERSKY, NORMAN & EDNA 320 NORTH MARKET STREET MECHANICSBURG, PA 17055 Please indicate: o FULL PAYMENT o 1 ST INSTALLMENT BILL #: 560 CASH CHECK # AMOUNT $ MAIL TO: FULL PAYMENT $1,291.13 $1,420.24 2% DISCOUNT TO 08131/07 FACE PENALTY 09/01/07 TO 10/31107 11101107 TO 12/31107 Barry L. Heckard Sr 605 Somerset Drive Mechanicsburg, PA 17055 111.111.1111111111.1111.1.1 $1,265.31 OR - If Paid On or Before 8/31/07 $430.38 I 111111111111 111111111111111 Itlllllll 11111111111111111111111 o W N E R 11588- 2245 I I I I I , ~ 8 I~I"'","''''' ...... al""-aN l8 .... ~ ii.... ..... . OCO 0 C ... '" .... . CIi 0 ~ CD ... .... co ~ a. 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PREMIUM PAYMENT NOTICE POLICYHOLDER LOAN NUMBER PAYMENT DUE BY CURRENT AMOUNT DUE ESTATE OF EDNA SWIDERSKY OCT 25, 2006 $ 363.50 POLICY NUMBER IDESCRIPTION I POLICY COVERAGE PERIOD 381-0066794504-01 BASICS SPECIAL DWELLING SEP 25, 2006 TO SEP 25, 2007 TO: POLICYHOLDER YOUR REPRESENT A TIVE ESTATE OF EDNA SWIDERSKY 601 FREEDOM RD MECHANICSBURG PA 17055 GUNN-MOWERY LLC PO BOX 900 CAMP HILL PA 17001-0900 (717) 761-4600 PAYMENT INFORMATION ,.,.,..,.,.,.,.""..",.",..".,.,.,.,..,...,.,.,.,.,.,.,.",.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.;.,.,. .............................. '1 :QqrlOJ~mqgntlMi:' :::i~1f...'.,I::i.$q:::::? OR, TO PAY IN FULL, PAY $ 715.00 THIS IS YOUR FIRST OF TWO PAYMENTS. FOR THE SCHEDULE OF FUTURE BILLS, SEE REVERSE SIDE. Have a question? Want to make a policy change? Just call your representative. Have a billing question or want to discuss your payment options? Call 1-800-532-4221 from lAM to 12AM EST, M-F. Form 8600 0(/06 - X - - - - ! - ~~E~~~ ~~~I!t! !~~ ~~~!l_~E!-~~ ~~H_ ~q~R_~R_E~~~~ ~~ ~~~~_ <?~ ~~ '! _~LJ~~ _ ,_ _ _ _ _ _ _ _ _ _ FOREMOST PAYMENT RETURN CARD FOR: ESTATE OF EDNA SWIDERSKY 1. ~~~eE:~~~hl~~:Ra::~: ~~MPANY GRAND RAPIDS, MICHIGANHH.::q:~~.I'III'~~liiiliil:iliiiii:ii 2. Please write your policy number on your check or money order. Policy Number: 381-0066794504-01 MAIL THIS CARD WITH YOUR PAYMENT TO: Amount Due: $ 363.50 FOREMOST INSURANCE COMPANY PO BOX 0915 CAROL STREAM IL 60132-0915 Date Due: OCT 25, 2006 Amount Enclosed $ '1~ 1/... ~ 1/0M4 Pa,,,,.,J 0066794504019 01013381000020060925 00000000 00000000 00071500 00036350 0 18-'90 r [ID@FOREMOST INSURANCE COMPANY GRAND RAPIDS, MICHIGAN Represented By Pay your bills online at www.ForemostPayOnline.com. GUNN-MOWERY LLC PO BOX 900 CAMP HILL PA 17001-0900 PREMIUM PAYMENT NOTICE POLICYHOLDER LOAN NUMBER PAYMENT DUE BY CURRENT AMOUNT DUE ESTATE OF EDNA SWIDERSKY SEP 25, 2007 $ 339.00 POLICY NUMBER IDESCRIPTION I POLICY COVERAGE PERIOD 381-0066794504-02 BASICS SPECIAL DWELLING SEP 25, 2007 TO SEP 25, 2008 TO: POLICYHOLDER YOUR REPRESENT A TIVE ESTATE OF EDNA SWIDERSKY 601 FREEDOM RD MECHANICSBURG PA 17055 GUNN-MOWERY LLC PO BOX 900 CAMP HILL PA 17001-0900 (717) 761-4600 PA YMENT INFORM A TION Q~ ~\-\\o'\ ct %\ ~, IQgtt@tlt~mpgmpy;: ......:....(iQ..:l OR, TO PAY IN FULL, PAY $ 666.00 THIS IS YOUR FIRST OF TWO PAYMENTS. FOR THE SCHEDULE OF FUTURE BILLS, SEE REVERSE SIDE. Have a question? Want to make a policy change? Just call your representative. For billing questions call our automated phone service, at 1-800-532-4221 available until midnight EST. We are available during normal business hours to assist you with questions or to discuss your payment options. FOtm 8600 12106 , PLEASE RETURN THE CARD BELOW WITH YOUR PREMIUM PAYMENT OR PAY ONLINE , - - -~ - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - .- - - - - - - - - - - - - - - - - - - - ~v ~ ~ I;,. '"" ~? ..... ~ ("\ ~ ~. 0- C . ~ ~ - C :J ' G ,.,. <: (: G\;- i.~ ~ Co "t.. {'\J o o IJ ~ ,"" uJ b 'e \ ...... "- --- ..... ~ '- o 0' 57 Claremont Nursing & Reha 1000 Clare~. t Drive Carlisle PA ,7013 (717) 243-2' '1 12 PATIENT NAME swidersky, Edna Swidersky Swidersky 601 Freedom Rd. Mechanicsburg, Pa 17055 42 REV. CD. 43 DESCRIPTION & · "'Y~~~,;c~"C:'~T':'>'~7 "/: '?;': ;~,;ftg~~ft~P~}]~~;~";;;;, ~ . ~ ~ ;: ~"., ;;:~' , ,;:>:;~;~ 0;;;::~0?"')/ / '; ." ", ',,- :. '~<.,' (~.n~1 ~n.}\,~,v-; .,'\. < ':' /\,,1: ,',:/ :\~?,:o/ ~/,,\s:; ~'. ","", \'..; '. ,< / -":'/ \'. '/,' .'>>.'/ -.: /~:-',' .<<: >; //"//;---'" 'J,,', '~'" '--'</.-".' I r __ 't~;,.,,,,/~,,r'.J""~,:.;"D~J'~ ,"'-., \.......t/-I'. \'.. 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