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HomeMy WebLinkAbout10-24-08 (2)15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Y ~ INHERITANCE TAX RETURN PO BOX 280601 2 :l 0 8 0 0 5 9 5 Hamsburg PA 17128-0601 - RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 4 4 4 2 4 8 8 2 0 1 2 8 2 0 0 8 0 7 1 3 1 9 5 1 Decedent's Last Name Suffix Decedent's First Name MI C Z A J K O W S K I F R A N C I S E (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 FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return C~ 3. Remainder Return (date of death prior to 12-13-82) O 4. limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litiga0on Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytirne Telephone Number F.a _ _, - ~~q i-~ , M c C A L E B 7 :L 7 6 .~,1 7~-7 7 ~~ ~ ~ -. Firm Name {If Applicable) M A R L I N First line of address 2 1 9 E A S Second line of address P 0 B O X City or Post Office M E C H A N I T M A I N S T R E E T 2 3 0 St t ZIP Code REGISTER OF WELLS USE QNLY `, ,, 4. . DATE FILED ae C S B U R G P A 1 7 0 5 5 Correspondent's a-mail address: Under pen ties of perjury, ecTare at ave examin this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, ct and co ete. e o of pre er ther than the personal representative is based on all information of which preparer has any knowledge. SIGN U F R O T ~/) .,~ D/A~TE ~ ~j ~ _.CSe! _~~~ L;L~ ADDR S ' 219 East Main Street, Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 ~ n ~__~ J 15056052048 REV-1500 EX Czajkowski, Francis E. Decedent's Name: Decedent's Social Security Number 1 4 4 4 2 4 8 8 2 RECAPITULATION 1 4 6 9 0 0 . 0 0 1. ............................................ Real estate (Schedule A). 2. ............................. Stocks and Bonds (Schedule B) .......... 2. 0 .0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 • 0 0 4. 9 9 ( ) ............................. Mort a es & Notes Receivable Schedule D 4. 0 . 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 8 4 2 7 2 • 4 4 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0 •0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0 (Schedule G) O Separate Billing Requested........ 7. • 8. Total Gross Assets {total Lines 1-7} .................................... 8. 1 3 1 1 7 2 . 4 4 2 3 9 1 5 8 8 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 7 6 4 •6 7 11. Total Deductions (total Lines 9~ 10) ................................ ... 11. 2 4 6 8 0 . 5 5 12. Net Vatue of Estate (Line 8 minus Line 11) ........................... ... 12. 1 0 6 4 9 1 • 8 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. • 1 0 6 4 9 1 8 9 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 0 0 (a)(1.2) X .0~ . . • 16. Amount of Line 14 taxable 1 0 6 4 9 1 8 9 4 7 9 2 1 4 at lineal rate X .0 45 • 16 • 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. . 18. Amount of Line 14 taxable 0 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 4 7 9 2 .1 4 Side 2 15056052048 15056052048 J REV-1500 EX Page 3 Decedent's Complete Address: File Number O~aijkawski, Francis B. __ STREET ADDRESS 533 State Street __ CITY __ _ _ _ - _ STATE ZIP Bnola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit __ B. Prior Payments C. Discount 3. Interest/Penaity if applicable D. Interest (1) 4, 792.14 ____ ___ Total Credits (A + B + C) {2) 0.00 (3) 0.00 {4) 0.00 (5) 4, 792.14 (5A) 0.00 (5B) 4, 792.14 _ _ __ E. Penalty Total InterestlPenalry (D + E 4. If Line'2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable fo: 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 :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its irxome :............................................ ^ c. retain a reversa~ry interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death oaurred after December 12, 1982, did decedent transfer properly within one year of death without receiving adequate censideration? .............................................................................................................. ^ 0 3. Did decedent own an in trust for" or payable upon death bank account or security at his or her death? .............. ^ X^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ 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 oi` 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) percer (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 an 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, a 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 i 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)]. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX ~ (1-97) SCHEDULE A COM INNER TANCE TAX RETURN ANIA REAL ESTATE t•at nunnestrs ESTATE OF Francis E. Cza'kowski SS~~ 144-42-4882 01/28/2008 21-08-0595 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 property which is jointly-owned with ri ht of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION NUMBER OF DEATH 1 House and lot - known and numbered as 533 State Street, Borough 46,900.00 of West Fairview, Cumberland County, PA, acquired by Decedent by deed of Charles J. Clouser and Mildred E. Clouser, his wife, dated 12/14/90 (Deed Book "X", Volume 34, Page 387). Value base on sale to Charles E. Cain, II, and Christina L. Cain, his wife, on 09/09/08. TOTAL (Also enter on line 'I, Recapitulation) ~$ 46 , 900.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) HUD -1 UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 7 Loan N„mher• A. u.a. u°r''""'""". " "... -- g. TYPE OF LAAN - - - 6. File Number: cain533 N/A 1. FHA 2. FmHA Mortgage Insurance Case Number 8 3. Conv. Unins. 4. VA . 5. Conv. Ins. N A C. NOTE: This form is famished to g ive you a statement of actual settlement costs. Amounts paid to and by the settlement agent are nd are not included in the totals. were paid outside the closing; they are shown here for informational purposes a NOTE: TIN =Tax is Identification Number NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: None AME ~ D. Frank Czajkowski Estate Charles E. Cain II Christina L. Cain 126 Creekside Drive c/o Marlin-R. McCaleb Esq. Enola, PA 17025 219 East Main Street Mechanicsburg, PA 17070 SETTLEMENT AGENT NAME, ADDRESS AND TIN H G. PROPERTY LOCATION: . t Robert P. Kline, Esq. -_ „~~,~~ ~~~~ 533 State Stree East Pennsboro Twp Enola, PA 17025 Tax Parcel #45-16-1050-OOlA 714 Bridge Street 7 I. 411 09/09/2008 Items marked "(p.o.c.)" ADDRESS 25-1797626 'DATE SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. (Sellers Signature) Frank Czajkowski Estate ® EASY SOFT, Inc. 2001 Previous editions are obsolete (Seller's Signature) Page t form HUD-1 (3/86) ref Handbook 4305.2 L. SETTLEMENT CHARGES AP. 1 1 LC,IYIC.1~ ^ ~.++~++~va.v ..• ON: I have carefully reviewed the HUD-1 Settlement Statement and to the best of my kno edge and made on ~y ac _ by eryr'Q this transaction. I further certify that Ireceived/ fthe Ijj~D< Seller Frank Czaj owski Estate PAID FROM PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT it is a true and accurate statement of all receipts and rles E. Cain IZ Seller Borrower Christina L. Cain The HUD-1 ement State ent which I have prepared is a true and accurate account of the funds disbursed or to be di;>bursed by the undersigned as part of the settlement of this transacti 09/09/2008 Settlement Agent Robert Peter Kline, Esquire Date WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. form HUD-1 (3/86) ref Handbook 4305.2 ® EASY SOFT, Inc. 2001 Previous editions are obsolete Page 2 REV -1508 EX + (1-97) SCHEDULE E p COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MSC. INHERITANCE TAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Francis E Czajkowski SS~~ 144-42-4882 01/28/2008 21-08-0595 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash in Decedent's possession. 1,105.00 2 (Commerce Bank Checking Acct. ~r`536148802, - principal balance as of D.O.D.: $6,859.30; interest accrued to D.O.D.: $0.14. 3 Commerce Bank Savings Acct. ~r<626109953, - principal balance as D.O.D.: $20,435.25; interest accrued to D.O.D.: $15.56. 4 M&T Bank checking account ~~950723739, - principal balance as of D.O.D.: $12,917.67; interest accrued to D.O.D.: $0.32. 5 1981 Ford F150 pick-up truck, - (value based on sale to Daniel L. Holcombe for parts on 08/26/2008). 6 1989 Ford Econoline E150 van, - (value based on sale tc Russ's Auto & Trailer Sales, LLC, for parts on 08/27/2008). 7 1999 Ford Ranger, - (value based on sale to Russ's Auto & Trail Sales, LLC, on 08/27/2008). 8 AAA, - refund of membership fee. 9 Assorted firearms, - rifles, handguns, kits - 39 piece:;; value based on sale of pieces to Shyda's Gun Shop and to Michael L. Norris. 10 Brotherhood's Relief & Compensation Fund, - retirement benefits 6,859.44 20,450.81 12,917.99 200.00 200.00 2,900.00 24.32 6,425.00 1,301.50 11 Masonic: ring, - 14 K. gold, engraved "Brotherhood of Locomotive 255.00 Engineers"; Timex wristwatch (stainless steel band); value based on oral appraisal by The Gold Mine, 57 W. Main St., Mechanicsburg, PA. 12 (New Jersey Transit Retirement System, - 401(a) Plan (1,543.078 I 31,633.38 units (~ $20.5001821). TOTAL (Also enter on line 5 84,272.44 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996formsoftwareonlyCPSystems,Inc. Form REV-1508 EX (Rev. 1-97) June 17, 2008 Marlin McCaleb Frankeberger Place 219 East Main St PO Box 230 Mechanicsburg, PA 17055 RE: Estate of: Francis E. Czajkowski Tax Identification Number: 144-42-4882 Date of Death: January 28, 2008 To Whom It May Concern: Commerce CBank This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 536148802 Date Opened: October 24, 2002 Primary Owner: Francis E. Czajkowski Date of Death Balance: $6,859.44 Accrued Interest: $.14 Principal Balance: $6,859.30 Account Type: Savings Account Number: 626109953 Date Opened: May 19, 2003 Primary Owner: Francis E. Czajkowski Date of Death Balance: $20,450.81 Accrued Interest: $15.56 Principal Balance: $20,435.25 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, ~~~ ~~~ ~ Cindy Shultz Support Associate/Deposit Services Commerce Bank Commerce Bank /Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com Page 1 of 1 REBECCA DORWART - Re: prod -Date of Death Request From: DATE OF DEATH REQUESTS To: DORWART, REBECCA Date: 6/20/2008 8:38 AM Subject: Re: prod -Date of Death Request To: Rebecca 6/20/2008 Please print a copy for your files. Please find below the date of death balance for: F E Czajkowski, social security # 144-42-4882 1. Account # 950723739, Balance $12,917.67 + accrued interest $ 0.32 = ;$12,917.99 total Records Management /DOD Unit M&T Bank- "Understanding what's important." r »> <rdorwart@mtb.com> 6/17/2008 12:19 PM »> Account Information Date of death: 01/28/2008 r Account Number: 950723739 Pfoduct Type: Deposit Account ,! 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A~ Gq W Coca ~~ O N O p M C/1 O~~~ ~O N M [~ M 01 ~ N ~ ~ ~ ~ ~ ~ ~ O ~ ~ ~ 00 a) O ~ ~ ~ O ~''~ ~ U N M M ~rl UaxwaaHNti~N ~ ~ Mc`1~C7NC7 ~ s~ ~,N ~+ U ~ ~ ~ ~ O\ OM N ~ ~ .Ni ~ .N-+ Q1 N N ~ OM N cti .--i U • .r t\ ~ N s, a1 ~ ~ ~ N N .yi ..`~~.' p ~ ~ ~ O O N ~ N O ~ ~ U '~ ' ~ ~ d' O ~ N ~ (~ N ~ N ~ ~ ~ ~ ~ ~ ~ ~ ~ C/] C/] cd ~, ~, N U N O ~ ~ U N ,~ ~ ,~ -~ Q, ~ ~ ~ Y N O ~ c~'d ~bq ~ bA ,~ U tri QE--~E-+a]S~v]v~U~Wv~r`L"E-~~ir`- ~a ~'' ~ N N N N N N~ M M M M M~ M M~~ TRANSIT •`~'~\;~~ ~ rle'~1~ay Tc Gc . '~~~~ ~`~~ T'c~: 17176917 r72 From: ~asolomon@njtransit.com Date: Auaust h, 2008 02:27:29 Frd ESi ~uk~ j Fran;: C~a jko{,ski Pages . :? m+l'r. Here is the information you requested. VVayn~ fix: a~•i~e Solomon N! '_'RA~TSI T Pension Depaatiueni l sU 8ovderi Ei•.'cnLe \laplawcx~c, N7 O'r~au iei: (973)3iR-ti15] lac ;S"3) 3~tc-6I .f. (DePc~;hnetd) Fay. '~?3) ^_()6-6b3G (Private) E-~lail~ wsolomonamjtransit corn 11ilIEIV1C)RANt~UM 14:14 '3?3-37--61'© PEFJSI!7N L~EP~RM=IdT PH(at Eil01 Pale 1. of I /ASSN; 744-4Z-4882 Name; FRANK E CZAJF pWS1(i Participant,Web.Site i~Yii:~ Trsnssction H-ratorY ~ , . ~ ~ r , ~® ~, AcGOUnt Balance by Maney Sources for 98973-02 Money Source Balance ~RB3 NJT PEN5i0N 37,633.38 Totai' 31,833.38 Total Vested Ba~ance; 31,633,3$ _ ...g '~~~'a+~le~iUG'~~.iz Select a new date to view between Aug-;~ i-2004 and today Jan ~ 28 ~, 2008 ~ I, ~~ :,,~ hct~?s:/!plan.retire:nentpartn.ct•.eom~'servlevPlanAccess~'PscBenc yip/esc_pa.rt_>•,t.i_mty~ 8/6/2008 REV-1511 EX +(1-97) ESTATE OF Francis E. Czajkowski SS~~ 144-42-4882 01/28/2008 FILE NUMBER 21-08-0595 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES• SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT 1 Sullivan Funeral Home, Enola, PA., - funeral expense. B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Marlin R. McCaleb Social Security Number(s) / EIN Number of Personal Representative(s) 26 - 6~+06010 Street Address 219 East Main Street City Mechanicsburg ~.~.~ nn ~:_ , ~„« Year(s) Commission Paid: 2008 2• Attorney's Fees Law Offices-Marlin R. McCaleb 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5• ~ Accountant's Fees 6• I Tax Return Preparer's Fees ~• Other Administrative Costs 1 Brett Lechthaler, - appraisal of real estate. 2 Cumberland Law Journal, - advertising Letters. 3 Karl R. Stine, - removal and disposition of household contents. 4 M. C. Walker Realty, - Realtor's commission on sale of house. 5 Paul's Garage, - commission on sale of vehicles. 6 Paul's Garage, - repair Ford Ranger and Ford Econoline van in preparation for sale. Total of Continuation Schedule(s) TOTAL (Also enter on line 9, F (If more space is needed, insert additional sheets of the same size) Copyright {c) 1996 form software only CPSystems, Inc. 2,409.00 5,000.00 5,000.00 300.00 75.00 900.00 3,283.00 465.00 159.00 6,324.88 ~) S 23,915.88 Form REV-1511 EX (Rev. 1-s7) Estate of: Francis E. Czajkowski Soc Sec ~~: 144-42-4882 Date of Death: 01/28/2008 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description ~~ Amount 7 PNC Bank, - check printing fee. 25.00 8 PuroClean Emergency Services, - clean and de-odorize firearms in * 2 015 16 preparation for sale. , . 9 Recorder of Deeds, - PA Realty Transfer Tax on sale of house. 469.00 10 Register of Wills, - Short Certificates. 8.00 11 Register of Wills, - Short Certificates. 8.00 12 Register of Wills, - Short Certificate. 4.00 13 Register of Wills, - filing Inventory and Appraisement . 30.00 14 Register of Wills, - reserve for filing Account, Releases, etc. 350.00 15 Register of Wills, - probate expense. 183.00 16 RestoreCore, - cleaning, de-odorizing and restoration of house in 3 098 41 preparation for sale; removal and disposition of toxic wast:e.* , . 17 The Patriot- News, - advertising Letters. 134.31 -------------- 6,324.88 *Decedent died in his home, alone, on or about January 28, 2008. His badly-decomposed body was discovered on the second floor of h_Ls house in early May. Bodily fluids had leaked through the second floor and down to the first floor. The entire interior of the house wa:; contaminated by the odor of decomposition. The only contents that could be' salvaged were Decedent's firearms (Schedule E, Item 9). The furniture and furnishings (mostly junk) could not be salvaged and had to be disposed of. The firearms and the interior of the house required extensive de-odorization. 1~IPQCIP,~II PuroClean Emergency Services 590 Centerville Road #133 Lancaster, PA 17601 Phone: (717) 898-7280 Fax: (888) 777-9497 Client: Marlin R. McCaleb Billing: 219 E. Main Street Mechanicsburg, PA 17055 Operator Info: Operator: DEAGER Estimator: Darlene Eager Type of Estimate: Bio-hazard Cleanup Date Entered: 6/25/2008 Price List: PAHASB8B Restoration/Service/Remodel Estimate: MCCALEBM_BIO File Number: 128-B-08 Date Assigned: Business:: (717) 691-7770 Fax.: (717)691-7772 Business;: (717) 989-5763 Received a call from Emily of Mr. McCaleb's office regarding 38 guns (hand guns, rifles, shot guns) that were in the home of Frank Czajkowski when he passed. PuroClean was asked to remove the odor that was on the guns and the cases. The guns were picked up from Mr. Michael Norris, Cumberland County Coroner's, office on Monday 6/'>_3/08 and returned to Mr. McCaleb's office on Thursday 6/26/08. All guns were cleaned and re-oiled. All cases were placed in an ozone chamber to remove the odor, cleaned with a Bio cleaning solution. (bactericide/viricide/germicide/sanitizer•/deodorant). FhIrGCleal~ PuroClean Emergency Services ..,.M,.r... 590 Centerville Road #133 Lancaster, PA 17601 Phone: (717) 898-7280 Fax: (888)777-9497 MCCALEBM BIO MCCALEBM_BIO DESCRIPTION QNTY CLEAN: Hand Gun 23.00 EA Each hand gun was cleaned with a special solvant and then re-oiled in order to remove residues and odor. CLEAN: Rifles/shotguns 15.00 EA Each rifle/shotgun was cleaned with a special solvant and then re-oiled in order to remove residue and odor. Hand Gun and Rifle/Shotgun carry case 32.00 EA Deodorization chamber -Ozone treatment 200.00 CF Grand Total 2,015.16 Darlene Eager Grand Total Areas: 0.00 SF Walls 0.00 SF Floor 0.00 SF Long Wal] 0.00 SF Ceiling 0.00 SY Flooring 0.00 SF Short Wall 0.00 SF Walls and Ceiling 0.00 LF Floor Perimeter 0.00 LF Ceil. Perimeter 0.00 Floor Area 0.00 Exterior Wall Area 0.00 Surface Area 0.00 Total Ridge Length 0.00 Total Area 0.00 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length 0.00 Interior Wall Area 0.00 Total Perimeter Length Coverage Amount % Grand Total Dwelling 0.00 0.00% 0.00 0.00% Other Structures 0.00 0.00% 0.00 0.00% Contents 1,901.09 100.00% 2,015.16 100.00% Total 1,901.09 100.00% 2,015.16 100.00% MCCALEBM_BIO 6/25/2008 Page:2 RestoreCore, Inc. 2322 North 7th Street Harrisburg, PA 17110 (717)232-1500 Frank Czajkowski Estate C/O Marlin McCaleb Attorney 219 E. Main St Mechanicsburg, PA 17055 ~. ~..,, ~ ~ RestoreCore® (~ Res[onng homes, businesses and lives. V ~ \\ ~ I 6~, INVOICE Dc~ `~ ~` INVOICE ID: 10273 ~` ,yam,- DATE: 06/18/2008 { _'~ DUE DATE: 06/28/2008 CONTRACT ID: 1008061012 Frank Czajkowski Estate LOCATION: Frank Czajkowski Estate 533 Stae Street Enola, PA 17025 Item I Description Id 1 Emergency Services - NonTax 2 Emergency Services -Taxable Total CUSTOMER ID: 13793 PO #: Total Previous Total This Billed Billed Invoice 460.00 460.00 2,489.07 2,489.07 2,949.07 I ~ 2,949.07 Sub Total: $ 2,949.07 Sales Tax Amount: $ 149.34 Total Due This Invoice: $ 3,098.41 Please Remit Payment to RestoreCore, Inc. 2322 North 7th Street, Harrisburg, PA 17110. Any questions, please call (717) 232-1500. Tax ID Number: 25-1767775 0EI17/2008 14:09 7172329°36 RESTORe.CORE PAGE 03104 RestoreCore Inc. 2322 North ?ih Street Harrisburg, Pa 1.71.10 717-'32-1.500 Faz 7I7-232-9436 EIN 25- t 767775 10.0806-ID12 General Serxicer Dl~SCR;IPTION Hazardous Was1G'7'rruma Cleaning Technleie» -per hour QNTY Note: 2 technieia.ns g^ 1.2 0 }tours each to mit(gate, and discard bio hazardous waste 24.00 HR . Apply a~,ti-rnierobial agent Add. for per,~tpl protective quipment {Hazardous cleanup) 115.00 SF Notes 2 tecn.tticians L Z set of PPE. 4.00 EA Respirator repiacetnent cartridge (per pair) Havl debris - Bio hazardous waste -per 401bs. of waste Z.00 EA 4 t)D EA Grand Total x,098.41 Grand Total. Areas: 953.78 SF Walls 329.77 SF Floor 0.00 SF Long Wail 329.77 Floor Arca 709.33 Exterior Wall Arca 0.00 Surface Area 0.00 total Ridge Lcttgth 329.77 SF Ceiling 36.64 5Y Flooring 0.00 SF Short Wall 365.94 Total Area 88.67 Exterior Peritncter of Walls 0.00 Number of Squates 0.00 Total Hip Length t,?83.55 SF Walls and Ceiling 117.67 LF Floor Perimeter 127.00 LF Ceil. >zerimcaer 953.7R Interior Wttll Arca 0.00 Total Perimeter Length Coverage amount "/o Crand Tota[ a/n Dwelling 2,945.00 .100.00% 3,.098.41 100 00% Other Sttuctures 0.00 0.00'/° 0.00 . 0 00°io Contents 0•~ 0.00% 0.00 . 0,00°!0 Total 2,945.00 100.00% 3,098.d l l00 ~o t0-0806-1012 6.~17J2008 Pagc:2 ~'6i;7i 208 14: e~9 71'i31~3936 E:ESrOREGORE PI~aE 04/©4 s fi S" ~ ii A a .9! ` ~ ~~ '+ iii ~~ ~~ ~~ ~~ i~ I { L .M ~ ~ i ~ i ~i ~ , I i ~~ ~ i ~ 1 .. ~ , ~~ ; ~ i i 1 ; - ~~ K f i f ~ i ~ ~ i ~, I ~r .~s~ d V ~~ ~5 M c bb~ O7J ~ .t9----.....~ JJ- ._ M _ ---, l ~' M ,' I j ; ~ i I~ f~~ ~~~ ~~ 1 OO REV-1512 EX + (~ -97) SCHEDULEI COM NHER TANCE~ AX RETURN ANIA DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Francis E. Czajkowski SS~~ 144-42-4882 01/28/2008 21-08-0595 Include unreimbursed medical expenses. Form REV-1512 EX (Rev. t-97) Copyright (c) 1496 form software only CPSystems, Inc. ~ '" ""' "'~°" "' "'C same srze/ REV-1513 EX ~ (9-00) SCHEDULE) COM NHER TANCE~Ax RETURN ANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF Francis E. Cza'kowski SS~~ 144-42-4882 Ol/2 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [includeoutrightspousaldistrlbutlons,and transfers under Sec. 9116(aX1.2)] Frank J. Czajkowski 90 Union Valley Road Monroe Township, NJ 08831 8 2008 21-08-0595 RELATIONSHIP TO DECEDENT AMOUNT OR SHi Do Not List Trustee(s) OF ESTATE father I entire estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15~THRU 18, AS APPROPRIATE, ON REV 1500 II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS S TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET IS (If more space is needed, insert additional sheets of the same size) 0 00 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. s-oo)