HomeMy WebLinkAbout04-0403 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003867
HALBRUNER MARK E
1013 MUMMA ROAD
SUITE 100
LEMOYNE, PA 17043-1144
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $5,400.00
ESTATE INFORMATION: SSN: 207-22-0506
FILE NUMBER: 2104-0403
DECEDENT NAME: SWILER CHARLES C
DATE OF PAYMENT: 04/27/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/07/2004
TOTAL AMOUNT PAID: $5,400.00
REMARKS:
CHECK# 2825
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV- 1500 EX (6-00) OFFICIAL USE ONLY
COMMONWEALTH OF
REV-1500
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN F LENUM.ER
2 I __ 04 0 4 0 3
HARRISBURG,
PA
17128-0601
RESIDENT DECEDENT oou coDE
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) [ SOCIAL SECURITY NUMBER
Sw L .R C I 207-22-0506
Z
IL! DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-OD-YEAR) TH~S RETURN MUST BE FILED IN DUPLICATE WITH THE
~ I 0 9 / 10 / 19 2 9 REGISTER OF WILLS
uJ ;!/7/2004
O
I, JJ (IF: APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
tu D(--~ E~ 2. Supplemental Return ] ] 3. Remainder Return (date of death priorto12-13-82)
l-- 1. Original Return
~ ~::"" E--] 4. Limited Estate ~L-J 4a. Future Interest Compromise (date of death a~ter 12-12~82) I I 5. Federal Estate Tax Return Required
,%,
~- OOr¢..~ E--~ 6. Decedent Died Testate (Attach copy of Will) E~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) __ 8. Total Number of Safe Deposit Boxes
u.<~ E--~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (da,e¢ daambet .... 12-31-91 a,d ,-,-ss) E~ 11. Election to tax under Sec. 9113(a) (^,,am sc, o)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
I-
z NAME COMPLETE MAILING ADDRESS
uJ
m ]~ARK E. HALBRUNER, ESQ. 1013 Mm Road, Suite 100
z
o
~. FIRM NAME (If Applicable)
-- GATES, HALBRUNER & HATCH, PC Lemoyne, PA 17043
O TELEPHONE NUMBER
O
717-731-9600
1. Real Estate (Schedule A) (1) 0 . 0 0 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) 0 .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.0:~. J':~'
4. Mortgages & Notes Receivable (Schedule D) (4) 0.0:0
5. Cash. Bank Deposits & Miscellaneous Personal Property 1 · 54 5 · 5'7
(Schedule E) (5) CC
~ 6. JointLy Owned Property (Schedule F) (6) 0 . 0 0 __.~
o_ [--]
I-- Separate Billing Requested
.X 123,566 · 30
,--I 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
::::) (Schedule G or L)
R' 125,111.87
.ti 8. Total Gross Assets (total Lines 1-7) (8)
O 4,504 O0
ILl 9. Funeral Expenses & Administrative Costs (Schedule H) (9) '
t 0. Debts o! Decedent. Mo~lgage Liabilities. & Liens (Schedule I) (10) 840. 22
1~ 1. Total Deductions (total Lines 9 & 10) (11) 5,3 44.2 2
112. Net Value of Estate (Line 8 minus Line 11) (12) 119,7 67. 65
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been 0. 0 0
made (Schedule J) (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 119,7 67. 65
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
t 5. Amount of Line 14 taxable at the spousal tax 0.0 0 0 0.00
z rate. or transfers under Sec. 9116 (a)(1.2) x .0 {15)
O
U- 119,767.65 45 5,389 5&
<[ 16. Amount of Line 14 taxable at lineal rate x .0 (16) '
I--
'-' O. O0 0 00
~- 17. Amount of Line 14 t~able at sibling rate x .12 (17) '
O 0.00 0.00
O 18. Amount of Line 14 taxable at collateral rate x .15 (18)
x
· ~ 5,389.54.
I-. 19. Tax Due (19)
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3w46451.000
Estate of 207-22-0506
Executors (Page 1)
Name Charles P. Swiler
Address 6229 Eton Place
Mechanicsburg, PA 17055-
Tax ID
Decedent's Complete Address:
STREET ADDRESS
406 Louisa Lane
Cumberland County
CI~W
Mec hani c sburg STATE ZIP
PA 17055-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 5,389.54
2. Credits/Payments
A. Spousal Poverty Credit 0.00
B. Prior Payments 5,400.00
C. Discount 270.00
Total Credits (A + B + C) (2) 5,670.00
3. Interest/Penalty if applicable
D. Interest 0.0 0
E. Penalty 0.00
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4) 280.4,6
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (55) 0.00
Make Check Pa to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make atransfer 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 income; ......... R
c. retain a reversionary interest; or ................................ E~]
d. receive the promise for life of either payments, benefits or care? ................. E~
2. if death occurred after December 12, 1982, did decedent transfer property within one year of death
withoul receiving adequate consideration? ............................ [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties o! perjury, I declare that I have examined this retum, including accompanying schedules and s atements and o he best of know edge and belief it is true, correct and complete.
Declaration oivp~reparer,~the, Ihan the~'~onal repren.~ative is based on all information ol which preparer has any kec~edge, my ,
'IGN:A~/~F,~N~ ~~G RETURN
5229 Eton Place Mechanicsburg, PA 17055
SIGNATURE/~ J~"OF PREP.~RER OTHER THAN REP~ENTATIVE DATE
1013 Mununa Road, Suite 100 Lemoyne, PA 17043
For dates of death on or after July 1, 1994 and before Jan uary 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S.§ 9916 (a) (1.1) (i)].
For dates of dealh on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1)
The statute does not exempt 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 tale imposed on the net value of lransfers 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 stepp~rent of the ch d is 0% [72 P.S. § 9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [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 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parenl in common with the decedent, whether by blood or adoption.
3W4646 1.000
REV-, O2E×* 16-981 SCHEDULE A
COM]VIONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CI{ARLES C. SWILER
,/%11 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 I0 buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule Fo
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1.
TOTAL (Also enter on line 1, Recapitulation) , $ 0. O0
3w4695 1.000 (If more space is needed, insert additional sheets of the same size)
REV-150~I EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHA~[LES C. SWILER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I VALUEAT DATE
OF DEATH
NUMBEi::t' DESCRIPTION
TOTAL (Also enter on line 2, Recapitulation)
3W4698 1,000 (if more space is needed, insert additional sheets of the same size)
REV-,~O. E×+ 16-981 SCHEDULE C
COMMOI'WVEALTH OF PENNSYLVAN]A CLOSELY-HELD CORPORATION,
liNHERITANCE TAX RETURN PARTNERSHIP OR SOLE-PROPRIETORSHIP
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
C~LES ~. S~ILE~
Schedule O-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM VALUE AT
NUMBER DESCRIPTION DATE OF DEATH
1.
TOTAL (Also enter on line 3, Recapitulation) $ 0.00 -
3w4697 1.000 (If more space is needed, insert additional sheets of the same size)
REV-1507 EX + (6-98)
SCHEDULE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN
RESIDENT DECEDENT RECEIVABLE
ESTATE OF FILE NUMBER
CHARLES C. SWILER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBEF DESCRIPTION OF DEATH
TOTAL (Also enter on line 4, Recapitulation $
0.00
3w46^c 1.000 (If more space is needed, insed additional sheets of same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
CHARLES C. SWILER
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 Internal Revenue Service Check
- 2003 Income Tax Refund 853.00
2 Property Management Inc. -
Brambles Apartments Refund 692.57
TOTAL (Also enter on line 5, Recapitulation) $ 1,545.57
3W46AD 1.000 (if more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLES C. SWILER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
JOINTI_Y-OWNED PROPERTY:
u:~ ~J-~ DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NJMEER OR SIMILA~ IDENTIFYING NUMBER. A"Ci'ACH DEED FOR
NUMBER TENANT JOINT JOINR-Y+IELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS iNTEREST
TOTAL (Aisc enter on line 6, Recapitulation) $ 0.00
3W46AE 1.000 (It more spaDe is needed, insert additional sheets of the same size)
.Ev-,~,0 E×+ <6-98) SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERIT~CETAX RETURN MISC. NON-PROBATE PROPERTY
RESIDE~ DECEDE~
ESTATE OF FILE NUMBER
CHARLES C. SWILER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM ~ TX NN~E ~ ~TRANSFEREE, THEIR RE~TIONS~P TO DE~DE~ A~) DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER TX ~ OF ~o, ANSEER A~AC~A ~ OF T~ DEED FOR RE~ ESTATE. VALUE OF ASSET INTEREST (iF ~PUC~LE) VALUE
1. 2000 Subaru Legacy Station
Wagon - Title transferred
Drior to death. (Sold for:) 10,000.00 100.000 0.00 10,000.0~
2 AIG Annuity Insurance Co.
Policy #AN201262 1,522.84 100.000 0.00 1,522.84
3 AIG Annuity Insurance Company
Contract #BX204795 32,261.55 100.000 0.00 32,261.55
4 AllFirst Bank IRA Account
#8-700-021-~725001 16,354.53 100.000 0.00 16,354.53
5 Blue Chip Federal Credit Union
Account #10551 (O~ened in
joint name with Charles P.
Swiler on 02/21/2003) 63,496.38 100.000 3,000.00 60,496.38
6 Cash gifted to Lee Swiler on
02/06/2004 3,000.00 100.000 3,000.00 0.00
7 Cash gifted to Neal Swiler on
02/06/2004 1,300.00 100.000 1,300.00 0.00
8 Cash gifted to Sue Johnson on
02/06/2004 1,000.00 100.000 1,000.00 0.00
9 Cash gifted to Charles P.
Swiler on 02/06/2004 3,000.00 100.000 3,000.00 0.00
10 M&T Bank Account #71675124
(Formerly AllFirst Bank)(Made
joint with Charles P. Swiler
on 02/21/03) 2,931.00 100.000 0.00 2,931.00
TOTAL (Also enter on line 7, Recapitulation) $
123,566.30
(If more space is ne~ed, insed additional sh~ts of the same size)
3W46AF 1.DO0
REV-1511 EX 4- (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN AD M INISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLES C. SWILER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cremation Society of
Pennsylvania 2,229.00
Total from continuation pages 450.00
B. ADMINISTRATIVE COSTS:
t. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / FIN Number of Personal Representative(s) - -
Street Address
City State ~ Zip
Year(s) Commission Paid:
2. Attorney Fees 1,500.00
3. Family Exemption: (if decedent's address is not the same as claimant's, attach e;q)lanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees 3,25.0 0
7.
TOTAL (Aisc enter on line 9. Recapitulation) $ 4, 5 04,. 0 0
3W46AG 1.000 (if more space is needed, insert additional sheets of the same size)
Schedule H Dart I (Page 2)
Estate of: CHARLES C. SWILER
Item
No. Description Amount
2 Funeral Flowers 150.00
3 Funeral Luncheon 200.00
4 Funeral Services (Pastor) 100.00
Total (Carry forward to main schedule) 450.00
REV-1512 EX + (6-98)
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENTDECEDENT MORTGAGE LIABILITIES, & LIENS
ESTATE OF
CHARLES C. SWILER FILE NUMBER
Include unreimbursed medical expenses,
ITEM
NUMB E R DESCRIPTION VALUE AT DATE
OF DEATH
1. Holy Spirit Hospital 279.30
2 MCI
45.03
3 Mid-Penn Urology 229.04
4 PA American Water Com13any 10.89
5 PP&L (Electric Utilities) 34.94
6 Solleriberger, Larry MD 194.07
7 UGI (Gas Utilities)
46.95
TOTAL (Also enter on line 10, Recapitulation) $ 840.2 7,
3W46AH 1.000 (If more space is needed, insert additional sheets of the same size)
E×+ <9-00 SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLES C. SWILER
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 [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Charles P. Swiler
5229 Eton Place
Mechanic sburg, PA 17055
100% Residue: 119,767.65 Son 119,767.65
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 o 0 0
3W46AI ~.000 (if more space is needed, insert additional sheets of the same size)
Estate of Charles C. Swiler
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT A
Certified Copy of the Death Certificate of the Decedent
Ti~is is to cerrif;, that the inr%rmation F given is co,'-}'ecdy copied £ro_:;~ an origin_al r 'f'ica~_e c,f dearie duly filed with me as
Local Registrar. The original certificate .... be r%rwa~:ded rD the ?5rate Vital Records O~,~ce fo_,- permanent _f]iiile
WARNING: It is illegal to dupl}cate 'ibis co,-:,,'....,, by.. photostat or photograph,
Dare
105.143 Rev 2]87
COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (First. MiddlB. Las,} SEX , SOCIAL SECURi1.;T~%;LEER~ ..... [ DAT~E. OF DEATI~ (Monll% Day. Year}
,.Charles C. Swiler I, Male I, -- 22 -- 0S06 I,g-7-
AGE {kasl Bin~ay} I UNDER 1 YEAR [ ~NDER 1 DAY DA~E OF B RTH BIRTHP~CE (City and IP~CE OF D~ATH {~heck only one - see inslmctions on olher side
~OUN~ O~ DE*~u [ - I ' . I ' 18~' M~m~ ~ ~* e"~ ~ ~S~} U
· ~" ,,b Construction / = I ~'~,0.,~ I2 ,,-,:,-, I ...... I
' ~ ' I~Z- I~. I I~-~uowe~ I~'
MAILING ADDRESS {Slreel. CRy~n. Slale. ZiD C~e) [ DECEDE~f'S
406 Louisa Lane [RESIDENCE
· s. Mechan~csburg. PA 17055 ~ on ol~f side) 17b. Co..y Cumberland ,~..,ip? ~.~ No. de~denlJived
wilNn aclual li~ls of Me chan i c 8 bur g citylboro.
~& Paul Swi let ~om~,,s NAME (F tM, Middle. Maiden Surname)
~.Lena Eshelman
Charles
Sw&ler
Eton Place, Meehanicsbur8, PA 17055
o,...~s..~l PA CrematoryS°ciety oFD~a. Harrisburg~ PA 17109
LICENSE NUMBER I NAME ANDADORESS O¢ FACILI~ Cremat ion Soc ie ty o f PA
=z=.4100 Jonestown Road, Harrisburg, PA 17109
CAUSE (Disease ~ inju~ c.
OF D~TH? Acddent D Pen~ Invesligal~ Yes ~ No ~ I
,,,. ~ ,,,. ~ . ~ ~;,:,~:,~;a~~ '
I
CERTIFIER (~e~ ~ly one) ~ -- J3~.
I'"- O~Og'-
DATE FILED (M~. Day. Yea0
Estate of Charles C. Swiler
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT B
PA Inheritance and Estate Tax Official
Receipt No. CD 003867 dated 04/27/2004
COIvlMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV-1162 EX(11-96)
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-060'i
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 0O3867
HALBRUNER MARl( E
1013 MUMMA ROAD
SUITE 100
LEMOYNE, PA 17043-1144.
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
..... 101 $5,400.00
ESTATE INFORMATION: SSN: 207-22-0506
FILE NUMBER: 2104.- 04.03
DECEDENT NAME: SWILER CHARLES C
DATE OF PAYMENT: 04/27/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/07/2004.
. TOTAL AMOUNT PAID: $5,400.00
REMARKS'
CHECK//2825
:", INITIALS: JA
SEAl_ RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
Estate of Charles C. Swiler
Pennsylvania Inheritance Tax Return
Form REV-I$00
EXHIBIT C
Documentation of Assets
1. M&T Bank Statement Account #71675124
2. Copy of Check from Property Management, Inc.
3. Copy of Title to 2000 Subaru Legacy Wagon
4. Copy of payment of AIG Annuity #AN201262
5. Copy of payment of AIG Annuity #BX204795
6. M&T Bank IRA Account #35004201770680 calculation
7. Copy of the Department of Revenue Statement re: Taxable value of Blue
Chip FCU Account #10551
ACCOUNT NO. ACCOUN1 TYPE ~ STATEMENT PERIOD I PAGE
7167512q RELATIONSHIP CHECKING WITH INTEREST FEB.iO-MAR.09,2000`} 1 OF 2
00 0 06125M NM I17
25O
CHARLES C. SWILER
CHARLES P. SWILER
5229 ETON PL
MECHANICBURG PA i7055
INTEREST PAID YEAR TO DATE 2.07 WEST SHORE PLAZA
ACCOUNT SUMMARY
BEGINNING DEPOSITS:& :: : ::: : :: :::OTHER: ::.: : :CURREN? ENDING
BALANCE OTHER ADDITTONSi :i!CHECKSiPAID: ~: ] SUBTRACTIONS : : :' INTiE:REST pD :BALANCE.
No.J AMOUNT NO.J AMOUNT No. J AMOUNT
11,230.88 0 0.00 9 8,659.70 0 0.00 0.25 2,$71
ACCOUNT ACTIVITY
:POSTING : : : ::' . :: DEPOSITS~INTEREST : CHECKS~g:OTHER:: . . DA:ILY i:
:DATE : · TRANSACTION DESCRIPTION g OTHER:ADDITIONS iSUBTRACTIONS : i : :BALANCE ':'
02-10-00` BEGINNING BALANCE $11,230.88
02-10-0c CHECK NUMBER 2798 ~'I1) 'Z. IG*/OCF $,000.00
02-10-0" CHECK NUMBER 2800 ~T~ ?~/C~/~L l,O00.O0 7,230.88
02-12-0" CHECK NUMBER 2799 ~'T~ ~/(o/C)~ 3,000.00
o2-12-o0`c.ECK .U.BER 2801 1, 00.00
02-23-00` CHECK NUMBER 2802 28.63~ ~2~902T. 25
03-03-00` CHECK NUMBER 2803 0,6.95
03-03-0~ CHECK NUMBER 2800` 3q.90` 2,820.36
03-Oq-Oq CHECK NUMBER 2806 2:38.29
03-Oq-Oq CHECK NUMBER 2805 10.89 2~571.18
03-09-0q INTEREST PAYMENT 0.25 2~571.q$
ENDING BALANCE $2~571.0`3
J : : : :! ::: : :: CHECK:S pATD.!$UNHARY!:: i
2798 02-10-04 3,000.00 2799 02-12-00` 3~000.00 2800 02-10-Oq 1,000.00
2801 02-12- Or} 1;300.00 2802 02-23-00` 28.63 2803 03-03-00` 0`6.95
2804 03-03-00` 3q.9~ 2805 05-00`-04 10.89 2806 03-00`-00` 238.29
ANNUAL PERCENTAGE YIELD EARNED = 0.10 X
L008A [1/03)
CERTIFICATEOF.TIT~E FOR A VEHICLE--
GCWF tITLE BRANDS
CHARLES C SNILER :;~F~':,u .......... ~,';~,~,~,r.~,;~.~,~.,,:~,,.'-':~-.
NECHANICSBURG p~ I ~)"~'~' ' '
· ~ , .-:
' .9:i;;:' -,...
· CHARLES C S~LEr .
406 LOUISA LANE
HECHAN[CSBuRG PA 17D55
wt~; be issued as ~enanls In Common" {On dea~ ol one o~er, interest
deceased owner goes Io hisser heirs or es~ale).
AIG Annuity Insurance Company
P.O. Box 871, Amarillo, TX 79105-0871 °
A Member of American International Group, Inc.
TRANSACTION STATEMENT
NAME: CHARLES SWILER March 08, 2004
POLICY: AN201262
TRANSACTION: FULL AND FINAL SETTLEMENT D/C
SOC-SEC: 1 84-48-8643
OWNER: CHARLES SWILER
DEATH CLAIM PAYMENT $ 1,522.84
AMOUNT OF CHECK $ 1,522.84
TAXABLE INCOME $000000000172.84
PLEASE DETACH AND KEEP THIS STUB FOR YOUR RECORDS
AIG Annoity Insurance Company
P.O. Box 871
Am,'u-illo, Texas 79105-0871
800.424.4990
MARCH 8, 2004
CHARLES P SWILER
5229 ETON PLACE
MECHANICSBURG, PA 17055
RE: Contract BX204795
Dear CHARLES P SWILER:
We are pleased to advise you that we completed processing your claim for annuity
benefits on March 08, 2004. In order to provide you with the benefit of
flexibility in disbursing your funds, we have opened an AIG Annuity Bridge
Account for you. .
The total amount of your claim proceeds is $32,261.55. The beginning balance
of your AIG Annuity Bridge Account is $32,261.55, as described below:
Non-Taxable Amount $30,000.00
Taxable Amount $2,261.55
Federal Tax Withheld $0.00
State Tax Withheld $0.00
$32,261.55
The taxable portion will be repor'ted on Internal Revenue Service Form 1099-R.
Your account will earn a competitive rate of interest and provide immediate
access to your funds with no monthly service charge. Int'erest earnings on your
AIG Anuuity Bridge Account will be reported as required by the Internal Revenue
Service.
State Street Bank and Trust will mail your new account kit shortly. The kit
will include your personalized checks and a detailed explanation of your
AIG Annuity Bridge. Account.
If you should have any questions, please call 1-800-331-4631.
Sincerely,
B. H. Graves
Manager Annuity Claims
AIG A.tmit)., ll~sura~ce Company
Mentber t¢'Americttrt Inter~ttttiotml Grottp. lilt'.
West Shore Plaza
August 20, 2004
1406
CHARLES £. SWILER
406 LOUISA LN
MECHANIGSBOR$ PA 170S0-7287
Re: Retirement Account Closing Notice
Account # 3~00420!'7'70680
Dear Charles C. Swiler,
We are writing to confirm that on 08/18/04, your Retirement account was closed 'or
transferred. At that time, the balance was $16,990.05. (DOD Value $16,345.53 - see attached)
If you are receiving scheduled distributions, the above account has been closed and
internally transferred to another Individual Retirement Account in your plan to
accommodate your next distribution.
We'd like to remind you that M&T Bank is committed to providing you with solutions to
all your financial needs. To find out more about the many ways we can help you with
those needs, simply stop by any. M&T Bank office or call the M&T Telephone Banking
Center at 716-626-1900 or 1-800-829-1924. Or if you'd like, visit the M&T website at
www.mandtbank.com.
Thank you for banking with M&T Bank.
Sincerely,
Michele Co£e-H~ctor
Michele Cole-Hector
Customer Service Manager
SMACCL /L~,RRS 1
Calculation of Date of Death Value of M&T IRA Account #35004201770680
Based upon information provided by M&T Bank (by telephone)
Actual Balance on 07/03/2003 15,558.45
Actual Balance on 01/03/2003 (15,045.32)
163 days (Interest) = 513.13
$513.13 + 163 days = $3.14 per day
Actual Balance on 08/18/2004 16,990.05
Actual Balance on 07/03/2003 (15,558.45)
411 days (Interest) = 1,431.60
$1,431.60 + 411 days = $3.48 per day
Average per diem interest = $3.31
Account Closed: 08/18/04 16,990.05
Date of Death: 02/07/04
192 days x $3.31 = (635.52)
.-. Account Balance on Date of Death $16,354.53
..... r--~g~..H~N~EALTU OF PENNSYLVANIA
DEPARTMENT OF REVENUE ~ INFORMATION
BUREAU OF INDIVIDUAL TAXES FILE NO 21 04-0405
DEPT. 2B0~01 AND '
HARRISBURG, PA ]7128-060! TAXPAYER RESPONSE ACN 04129556
e~,-~s~ ~ ,,e,, (o,-oo, DATE 07 - 2
TYPE OF ACCOUNT
EST. OF CHARLES C SWILER [] SAVINGS
S.S. NO. 207-22-0506 [] CHECKING
DATE OF DEATH 02-07-2004 []TRUST
COUNTY CUMBERLAND [] CERTIF.
REMIT PAYMENT AND FORMS TO:
*~ CHARLES P SWILER REGISTER OF WILLS
5229 ETON PL CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
BLUE CHIP FCU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the £ommonwea]th
of Pennsylvania. Questions may be answered by calling (717) 75?-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE sIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 10551-C Date 02-21-2003 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
payment to the Register of Wills. Make check
Account Balance ~3 · ~ . 38 payable to: "Register of Wills, Agent".
Percent Taxable X 100. O0
NOTE: If tax payments are mede within three
Amount Sub3ect to Tax
(~) months of the decedent's date of death,
Tax Rate X · 0~5 you may deduct a 5Y. discount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due 2,857,3~ nine (~) months after the date of death.
PART TAXPAYER RESPONSE
A. ~-~ The above information and tax due is correct.
I. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
CHI--CK ~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Hills and-an official assessment will be issued by the PA Department of Revenue.
ONE
BLOCK B. ~The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY ~to be filed by the decedent's representative.
C. [] The -above information is incorrect and/or debts and deductions were paid by you.
You must complete PART [] and/or PART [] below.
PART If you indicate a different tax rate, please state your
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE l. Date Established 1
2. Account Balance 2
~. Percent Taxable ~ X
4. Amount Sub~ect to Tax
5. Debts and Deductions 5
6. Amount Taxable
7.. Tax Rate 7 X
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (':En'ter on Line,-5-of Tax ~.omputa.tion)
.~-,, Under penalties of p~t~]ury, T declare that' the facts~oI~yha~e'HOMErepl~.~F,~edi~ -~ above are true, correct and
Estate of Charles C. Swiler
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT D
2. Documentation of Expenses
Nationwide
~°z' "The Simple Dig~ified Choice" 1-800-722-8200
2-7-2004 240173 LF-5
Mr. Charles Swller
5229 Eton Place
Mechanicsburg, PA 17055
Charles C. Swiler - Deceased
X Direct Cremation $1,150.00
Special 48 Hour Or Weekend Cremation Service
Nationwide Guarantee Program
Worldwide Travel Protection Program
Private Family Viewing/Witnessing Cremation
Cremation Container
X Medical Document/Courier Fee $55.00
X Meadow Green Cultured Urn $215.00
Urn Burial Vault
Arrange For Burial
Personal Delivery of Cremated Remains
X Arrange/Deliver Remains To A National Cemetery $85.00
Scattering Charge
Packaging And Forwarding Of Cremated Remains
Express Mail
X Certified Copies 12 @ $2.00 $24.00
X Register Book $0.00
X Memorial Folders 100 @ $45.00 $0.00
X Thank You Cards # 2 @ $7.50 $0.00
X Memorial Service Package $80.00
Flowers
Newspapers
X Harrisburg Patriot
X Cumb. County Coroner Cremation Approval Fee $25.00
DNA Preservation
X Engraving and Desing on Urn $70.00
X Rental of Z/A Funeral Home $475.00
TOTAL $2,179.00
2-9-2004 PAID $2,179.00
BALANCE DUE $0.00
www.cremationsocietyofpa.com
. ~ ~ ~. ~ ~
Ch~ck ~2816 ~aid :04/08/200~ 18.96 Ch~ck ~2808 P~id :03/24/2004 16.40
'OUNT PAGE
00000007167512Q 2 OF 2
Chsck ~2798 Paid :02/10/2004 3000.00 Check ~2799 Paid :02/12/2004 3000.00
Ch,~ck ~2800 Paid :02/10/2004 1000,00 Ch~ck ~801 Paid :0~/12/2004 1300.00
Ch~ck ~2802 Paid :02/23/2004 28.63 Ch~ck ff2803 Paid ;03/03/2004 46.95
C]Aeck ~2804 P~d :03/03/2004 34.94 Ch~ck ~2805 Paid :03/04/2004 10.89
BUREAU Of INDIVIDUAL TAXE~ECO((jED ():
INHERITANCE TAX DIVISION ,"' I'
PD !.DX 2.&06D1 :.-; .
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'-'c- r;r-
'i'i '\: ui' NOTICE OF INHERITANCE TAX
A~PR~ISEHENT, ALLOWANCE DR DISALLOWANCE
, 'Of'DEDUCTIoNS AND ASSESSHENT OF TAX
2005 JAN I 0 ~H S: 48
ClER,<' Or
ORPHAN'S cQ~nT ,
MARK E HALBRUNrn~~\ ",r" i,l) , ~;'
GATES ETAL
1013 MUMMA RD STE 100
LEMOYNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-10-2005
SWILER
02-07-2004
21 04-0403
CUMBERLAND
101
Aatount R....i tt..s
*'
Rl:V-15~7 EX AFP (12-D4)
CHARLES
C
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
RiV=is4";-EX--AFP--riir=oiY-tioT"i"CE"OF-YN'iiEifi"TANCE-YA'x-jipPRA"{sEM.iNT~--ALLoWANCE-iiR------"----------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SWIlER CHARLES C FILE NO. 21 04-0403 ACN 101 DATE 01-10-2005
TAX RETURN WAS: [X I ACCEPTED AS FILED
I CHANGED
NOTE: I~ an assessmen~ was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lec~ ~igures ~ha~ include ~he ~o~al o~ ALL re~urns assessed ~o da~e.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. AMount oi Line 14 ~ax8bI. at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.00 X 00 = .00
119,767.65 X 045 = 5,389.54
.00 X 12 = .00
.00 X 15 = .00
1l91= 5,389.54
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notas Receivable (Schedule 0)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule fl
7. Transfers (Schedule G)
8. Total Assets
III
(21
[31
(41
(51
[61
[71
.00
.00
.00
.00
1,545.57
.00
123,566.30
[81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value oi Tax R.turn
13. Charitable/Governmental Bequestsi Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
[91
llOI
4,504.00
840.22
1111
1121
1131
1141
NOTE: To insure proper
credit to your account~
submit the upper portion
oi this form with your
tax payment.
125, Ill. 87
5.344 ?2
119,767.65
.00
119,767.65
TAY CD"DTT".
.. '.J AMOUNT PAID
DATE NUH8ER INTEREST/PEN PAID (-I
04-27-2004 CD003867 269.48 5,400.00
TOTAL TAX CREDIT 5,669.48
BALANCE OF TAX DUE 279.94CR
INTEREST AND PEN. .00
TOTAL DUE 279.94CR
~
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. <)t'~
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CRI, YOU HAY 8E DUE ,.,,,
A REFUND. SEE REVERSE SIDE OF THIS FoRH FOR INSTRUCTIONS. I "
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'.....i'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
MARK E HAL BRUNER ESQ
GATES ETAL
1013 MUMMA RD STE 100
LEMOYNE PA 17043
'*
REY-1U7 EX AFP 112-041
02-22-2005
SWILER
02-07-2004
21 04-0403
CUMBERLAND
101
CHARLES
C
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ......
IlV::l'&'b.,.!r.AI!"..r8r-.lfJ'......'i;..,.AMM!n"Ner"'fAy.~'lYI!Al1r1'.o.,..l~1!'6'OFN........................ ...
ESTATE OF SWILER CHARLES C FILE NO.21 04-0403 ACN 101 DATE 02-22-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-03-2005
PRINCIPAL TAX DUE:.
PAYMENTS (TAX CREDITS):
5,389.54
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-27-2004 CD003867 269.48 5,400.00
01-31-2005 REFUND .00 279.94-
TOTAL TAX CREDIT 5,389.54
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
"
,
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J