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04-0430
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003897 REAGER DAVID W ESQ 2331 MARKET ST CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .- 101 $10,000.00 ESTATE INFORMATION: SSN: 195-07-5550 FILE NUMBER: 2104- 0430 DECEDENT NAME: SCHWlNGHAMMER LOUISE A DATE OF PAYMENT: 05/03/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/03/2004 TOTAL AMOUNT PAID: $10,000.00 REMARKS: KAREN BERTOLETTE CHECK# 288370137-6 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Hll)5.8{)5 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar P 9962456 -~' ': FEB 0 5 :~04 No. Date ~ ;'~ ~, ~'a7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH ,, VITAL RECORDS CERTIFICATE OF DEATH ? Louise A. Schwinghamer ~~,~%%%%~%'~"" ~ . ~H ' J ~____ J" iT. Ii.r .......... --a U ~ J~ ~ ~.~r~ano / Mechanics~ro J '- ~'*~'~' I~S~CE~m~:=¢~iN, ,~ ~ - ~h vm~ge ~.mng "~e I~~~ I~ ' · wnl ~e I, ,, nagment Anyst. ~,~wis~rry, Pa. 17339 J~ York ~ ....... 1 m ~teDhen ~ f~ ~ ~~uerry ~?~%~ =o~e=z ~ Karen A. Bertolett" "~- -~ e ~y, Pa. 17339 ~~~ 9,2004 '~ Gap P.O.Box 287 12 .e Pa. 17~3 ~,~ H~e, Inc. 7102 ___. . .............................. ..................... ' ................ ~-' .... ~ /V~ ~ S~. ~oy~ ~, C~mber"l&nd County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Louise A. Schwin~lhammer No. 21-04-0430 also known as , Deceased Social Security No. 195075550 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or named in the Last Will of the ~'~ Decedent, dated 11/12/96 and codicil(s) dated n/a State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia dura.nt~ minodtate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was suONed by th~following spOuse (if any) and heirs: r Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at Messiah .Village Nursin~l Home (list street, number and municipality) Decedent, then 86 years of age, died February 3 ,2004 , at Messiah Villa~le Nursin~l Home (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $, 29,095.78 (if not domiciled in PA) Personal property in Pennsylvania .................... $, (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $. Tota~ ..................................................................................................................... $. 29,095.78 Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence I I ~ ~ ~/~ //CC_ Karen A. Bertolette 783 Old Quaker Road Lewisberry, PA 17339 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate ac, c~ding to law. Sworn to and affirmed and subscribed , before me th s Zcl-r t dayof DECREE OF REGISTER Estate of Louise A. Schwinohammer Deceased No. 21-04-0430 also known as Social Security No: 195075550 Date of Death: 2/3/04 AND NOW, ~,~'L,~ 2~ , 2004 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary I-I of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) are hereby granted to Karen A. Bertolette in the above estate and that the instrument(s), if any, dated November 12, 1996 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. ....~. ........ $ I~:). ~) 0 / Register'ofWills ~'~ V~~. Short Certificate(s) Renunciation .......................... $ /.~~,/. , Affo~rn~v~~_~_~1_,~ i,~-~.~i~.--, Affidavit ( ) ....................... $ ~ ~ Extra Pages ( I~ ) .............. $ ''''~ -0 0 ~ Codicil ................................. $ JCP Fee ................................. ~ i~ ~) Attorney: David W. Reacjer Inventory & Tax Forms ............. $ I.D. No: 20868 Other ...................................... $ Address: 2331 Market Street TOTAL ............................. $ [~.i ~)-~ Camp Hill PA 17011 ' Telephone: 717-763-1383 DATE FILED: RW-7A This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. Fee Gr this certificate, $2.00 ~~~, Local Registrar P 9962471 No. ~ Date ~::. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,. Louise A. Schwinghamer I~emale I~g~cu'~'%"~" 5550 ~ : , . - O~ .. v.I ~ ] [ ~uly 20,1917~rrls~rg,Pa I~--~ .~--~ ~ I~ ...... ~ c~r~and ] Hec~nics~rg I ...... ' . ' I~'~~~ I~ ~ Im. [~essxah V~LLage Nurszng H~e I~~~ ,,.~nag~ent Anyst. I,Qlmsted A F ~se I ~u ~ I'~I ,~., I .... ~ ..... ~.~.~.~.~.~, . I - I I,~ J,~ 783 O~d ~akec Road ~ ~'= ...~ ,~s~ccy,__ ~a. Z73J9 ~ Yock ~" ,~ S Lep~en A. ~t. ~ulse IN1KAeS ~ZS[?_~: Bortolette [~Y*I~rmo~ewz~rry, Pa. 17330 I,,. / ol~ggruary 9,2~4 ~ndiantom Gap National : "I P.9.~.187 ~~' I' - I E i~- ~/~/~ I ..~ ~ dlb\wi 11 s \ schwing hamer. 1 November 12, 1996 L~ST WILL ~ TESTi%MENT OF LOUISE SCH~IN~IL%I~ER I, LOUISE SCHWINGHAMER, of Mechanicsburg, Cumberland County Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior wills and codicils'thereto by me at any time heretofore made. I direct that all my just debts and the expenses of my last illness and funeral shall be paid from the assets of my estate as soon as practicable after my decease. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. I direct that I be buried next to my late husband, Albert O. Schwinghamer, at the Fort Indiantown Gap Military Reservation. I give and bequeath all automobiles, household effects and other tangible personal property, not including cash or securities, owned by me at my death, together with all policies of insurance thereon, to my daughter, KAREN BERTOLETTE, providing that she is living on the sixtieth (60th) day after the date of my death. Should my daughter, KAREN BERTOLETTE, not be living on the dlb\wills\schwin~hamer.l' November 12, 1996 sixtieth (60th) day after the date of my death, I bequeath such tangible personalty and insurance thereon as follows: A. One fourth (%) of my personal estate to my grandson, ROBERT BRIAN BERTOLETTE. In the event ROBERT BRIAN BERTOLETTE is not living on the date of my death, then his share shall pass to his issue, per stirpes. B. One fourth (%) of my personal estate to my grandson ROBERT BRIAN BERTOLETTE'S issue as are living on the date of my death. C. One fourth (%) of my personal estate to my granddaughter, TRACY ANN QUICKEL. In the event TRACY ANN QUICKEL is not living on the date of my death, then her share shall pass to her issue, per stirpes. D. One fourth (%) of my personal estate to my granddaughter TRACY ANN QUICKEL'S issue as are living on the date of my death. Any item of personalty passing to a minor under this paragraph shall be given to the minor or to the parent(s) or guardian(s) of said minor, in my Executor's sole discretion. The receipt of the personal property by the minor or the parent(s) or guardian(s) of the minor shall constitute a full and complete discharge of my Executor with regards to said items of personalty. I give, devise and bequeath the residue of my estate, of every nature and wherever situate in equal shares to my daughter, KAREN 2 dlb\wills\schwin~hamer.l' November 12, 1996 BERTOLETTE, providing that she is living on the sixtieth (60th) day after the date of my death. In the event my daughter, KAREN BERTOLETTE, is not living on the sixtieth (60th) day after the date of my death, then I give, devise and bequeath the residue of my estate, of every nature and wherever situate, as follows: A. I give and bequeath my real property located in Ft. Myers, Florida, to my son-in-law, DONALD BERTOLETTE. B. One fourth (%) of the remaining residue of my estate to my grandson, ROBERT BRIAN BERTOLETTE. In the event ROBERT BRIAN BERTOLETTE is not living on the date of my death, then his share shall pass to his issue, per stirpes. C. One fourth (%) of the remaining residue of my estate to my grandson ROBERT BRIAN BERTOLETTE's issue in equal shares as are living on the date of my death. D. One fourth (%) of the remaining residue of my estate to my granddaughter, TRACY ANN QUICKEL. In the event TRACY ANN QUICKEL is not living on the date of my death, then her share shall pass to her issue, per stirpes. E. One fourth (%) of the remaining residue of my estate to my granddaughter TRACY ANN QUICKEL'S issue in equal shares as are living on the date of my death. In the event either of my grandchildren, ROBERT BRIAN BERTOLETTE or TRACY ANN QUICKEL, who are entitled to a share of the 3 dlb\wills\schwin~hamer.l' November 12, 1996 residue under Item Third has not yet attained the age of forty (40) years at the time for distribution to him or her, then I give, devise and bequeath the share of each such beneficiary to my trustee hereinafter named, IN TRUST, nevertheless, upon the following terms and conditions: A. The income and so much of the principal as may, in the sole discretion of my trustee, be necessary for the maintenance, support, medical expenses, and education of the beneficiary, shall be paid to the beneficiary or shall be applied directly for his or her benefit. B. Any income not so paid or applied shall be accumulated and added to such beneficiary's share of the trust estate. C. Any income and principal remaining in such beneficiary's share of the trust shall be distributed to such beneficiary when he or she attains the age of forty (40) years. D. In the event any such beneficiary who has not yet attained the age of forty (40) years at the time of my death dies before distribution of his or her entire principal share, then such share shall be distributed to such beneficiary's then living descendants, per stirpes. E. Any income or principal payable to a beneficiary under this Item Fourth may be accumulated or expended for the maintenance, support, medical expenses, or education of 4 dlb\wills \ schwin~hamer. 1 November 12, 1996 such beneficiary as the trustee, in his sole discretion, may determine. My trustee may, in his discretion, pay the said income or principal directly to the beneficiary, to the person having the care or control of such beneficiary, or to any institution entitled to such payment by reason of services rendered to or to be rendered to said beneficiary, without the intervention of a guardian. In the event any great-grandchildren of mine who are entitled to a share of the residue under Item Third has not yet attained the age of thirty (30) years at the time for distribution to him or her, then I give, devise and bequeath the share of each such beneficiary to my trustee hereinafter named, IN TRUST, nevertheless, upon the following terms and conditions: A. Any and all trust accounts established for the benefit of any or all of my great-grandchildren shall be established and administered as separate trusts. B. The income and so much of the principal as may, in the sole discretion of my trustee, be necessary for the maintenance, support, medical expenses, and education of the beneficiary, shall be paid to the beneficiary or shall be applied directly for his or her benefit. 5 dlb\wil 1 s \ schwin~hamer. 1 November 12, 1996 C. Any income not so paid or applied shall be accumulated and added to such beneficiary's share of the trust estate. D. Any income and principal remaining in such beneficiary's share of the trust shall be distributed to such beneficiary as follows: 1. One half (%) of the trust estate shall be distributed to the beneficiary when he or she reaches the age of twenty-five (25) years. 2. The remaining trust estate shall be distributed to the beneficiary when he or she reaches the age of thirty (30) years. E. In the event any such beneficiary who has not yet attained the age of thirty (30) years at the time of my death dies before distribution of his or her entire principal share, then such share shall be distributed to such beneficiary's then living descendants, per stirpes, absolutely; or in default of such descendants, it shall be distributed in accordance with Item Third of this Will. F. Any income or principal payable to a beneficiary under this Item Fourth may be accumulated or expended for the maintenance, support, medical expenses, or education of such beneficiary as the trustee, in his sole discretion, may determine. My trustee may, in his discretion, pay 6 dlb \wil 1 s \ schwin~hamer. 1 November 12, 1996 the said income or principal directly to the beneficiary, to the person having the care or control of such beneficiary, or to any institution entitled to such payment by reason of services rendered to or to be rendered to said beneficiary, without the intervention of a guardian. All principal and income, until actual distribution to the beneficiaries, shall be free of the debts, contracts, assignments, alienations and anticipations of any beneficiary, and the same shall not be subject to any levy, attachment, execution or sequestration. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expenses of the administration of the estate. My personal representative and trustee shall have the following powers in addition to those vested in them by law and by other provisions of this Will: A. To retain any or all assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. 7 dlb\wills\schwin~hamer.l' November 12, 1996 B. To invest in all forms of property as my fiduciary may deem proper, without regard to any principle of diversification, risk or productivity. C. To purchase investments at a premium or discount. D. To exercise all rights of a security holder or shareholder in any corporation; to give proxies; to join in any merger, consolidation, reorganization, voting trust plan, or other concerted action of security holders; and to delegate discretionary duties with respect thereto. E. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as my fiduciaries deem proper. F. To allocate receipts and expenses to principal or income, or partly to each. G. To borrow money from my corporate fiduciary or others and to mortgage or pledge any real or personal property as security therefore, in their sole discretion. H. To compromise any claim or controversy without order of court or consent of any beneficiary. I. To exercise any option, right or privilege granted in insurance policies or arising from ownership of investments. 8 dlb\wills\schwin~hamer.l' November 12, 1996 J. To make any distribution herein provided for in cash, in kind, or partly in each, at valuations fixed by my personal representative or trustee at the time of distribution. K. My fiduciary may, in his or her sole discretion, donate any part or all of my tangible personal property to any charitable organization(s) which would benefit from such donation. My fiduciary is then instructed to use the value of said donation(s) as an tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. I appoint my daughter, KAREN BERTOLETTE, Executrix, of this, my Last Will and Testament. Should my daughter, KAREN BERTOLETTE, predecease me or for any reason fail to qualify as such Executrix, or having qualified, fail to serve as such Executrix, then I nominate, constitute and appoint my son-in-law, DONALD BERTOLETTE, of Lewisberry, York County, Pennsylvania, Executor of this My Last Will and Testament. I appoint my son-in-law, DONALD BERTOLETTE of Lewisberry, York County, Pennsylvania as trustee of the trusts created under this Will. If the aforesaid Donald Bertolette is unable or unwilling to act or to continue to act in that capacity, then I appoint RALPH W. 9 dlb\wills\ schwin~hamer. November 12, 1996 WIRE, JR. of Mechanicsburg, Pennsylvania as Trustee of the trusts created under this Will. My Executrix and trustee shall not be required to post security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of ten (10) typewritten pages, the first nine (9) of which bear my signature in the margin for the purpose of identification, this day of November, 1996. LOUISE SCHWINGHAMER, Testatrix 10 dlb\wills \schwin~hamer. 1 November 12, 1996 Signed, sealed, published and declared by the above-named Testatrix, LOUISE SCHWINGHAMER, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. 11 dlb\will s\ schwin~hamer. 1 November 12, 1996 COMMONWEALTH OF PENNSYLVANIA ) : SS: COUNTY OF CUMBERLAND ) I, LOUISE SCHWINGHAMER, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO AND ACKNOWLEDGED BEFORE ME BY LOUISE SCHWINGHAMER, THE TESTATRIX THIS /3-~- DAY OF NOVEMBER, 1996. LOUISE SCHWINGHAMER, Testatrix Notary Public ...... NOTARIA- .'SEAL "' m RHONDA L. WOODS, Nolary Public I COMMONWEALTH OF PENNSYLVANIA ) Camp Hill B~'o. Cum~Jl~d O~nty : s s: My Commission Expi~,Sept, 1,1997,,,. COUNTY OF CUMBERI.~%!~TD ) '.~mber. Pennsylvania Association ol Notaries BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. SWORN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS DAY OF NOVEMBER, 1996. Witness Witness I ..... NOTARI~['§7..AL " RHONDA L. WOODS Notary Public Camp Hill Boro. Cum~fland County ,My Commission Expires Sept. 1,1997 Member, Pennsylvania As~,~'iation of Notaries REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + SUSAN H. CONFAIR DAVID W. REAGER JOANNE HARRISON CLOUGH CHARLES E. ZALESKI THOMAS J. ROZMAN LINUS E. FENICLE TIFFANY M. CARTWRIGHT DEBRA DENISON CANTOR PETER R. WILSON THOMAS O. WILLIAMS SUSAN J. SMITH +CerUfied Civil Trial Specialist Writer's E-Mail Address: MZercher@ReagerAdlerPC.com July 15, 2004 Hand Delivered via Courier Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Louise A. Schwinghamer Estate File No. 21-04 0430 . · Our File No. 86-245.002 To Whom It May Concern: Attached please find an Inventory and Inheritance Tax Return for the Estate of Louise A. Schwinghamer. Also attached is a check in the amount of $28.00 for the filing fees for the above- referenced Inventory and Inheritance Tax Return and a check in the amount of $2,295.48 for payment of the balance of the inheritance tax due. Please file the original with your office and return the time-stamped copies with our courier. Thank you for your attention to this matter. In the event you should have any questions, please feel free to contact me. Vex truly yours, Monica D. Zercher Legal Assistant MDZ/bab Enclosures COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004162 REAGER DAVID W ESQ 2331 MARKET ST CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 92,295.48 ESTATE INFORMATION: SSN. 195-07-5550 FILE NUMBER: 2104- 0430 DECEDENT NAME: SCHWlNGHAMER LOUISE DATE OF PAYMENT: 07/15/2004 POSTMARK DATE: 07/1 5/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/03/2004 TOTAL AMOUNT PAID: 92,295.48 REMARKS: M &TINVESTMENTGROUP C/O DAVID W REAGER CHECK# 083548666 INITIALS: SK SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV~15OO EX + (6-00) OFFICIAL USE ONLY REV-1500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN F,LE.U.BER DEPT. 280601 HARR.SBURG, PA17128-0601 RESIDENT DECEDENT 2 1 - 0 4 0 4 3 0 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl. SOCIAL SECURITY NUMBER SCHWINGHAM~gR ,LOUISEA. 1 9 5- 0 7- 5 5 5 0 DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD.Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 02/03/2004 I 07/20/1917 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~-] 1. Original Return r-'] 2. Supplemental Retum r~ 3. Remainder Return (date of death p~lo 12-13-82) D 4. Limited Estate E~ 4a. Future Interest Compromise (date of death after 12-12-a2) r--] 5. Federal Estate Tax Return Required r-'] 6. Decedent Died Testate (A~ch copy of Will) E] 7. Decedent Maintained a Living Trust (A~tach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes r-] 9. Litigation Proceeds Received r-'] 10. Spousa~ Povel'~ Credit (date of death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A)(Attach Sch O) NAME COMPLETE MAILING ADDRESS DAVID W. REAGER 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER, P.C. TELEPHONE NUMBER 7170763-1383 CAMP HILL PA 17011 ~' C~! OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) - 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 184,766.84 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 120,O34.93 r~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 304,801.77 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 13,659.19 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 6,798.59 11. Total Deductions (total Lines 9 & 10) (11) 20,457.78 12. Net Value of Estate (Line 8 minus Line 11) (12) 284,343.99 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 284,343.99 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X (15) 16. Amount of Line 14 taxable at lineal rate 284,343.99 X .045 (16) 12,795.48 17. Amount of Line 14 taxable at sibling rate X .12 (17) 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19. Tax Due (19) 12,795.48 20. E~] Decedent's Complete Address: STREET A; DRESS Messiah Village Nursing Home c~TY Grantham STATE PA I ZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 12,795.48 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 10~000.00 C. Discount 500.00 Total Credits (A + B +C) (2) 10,500.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestJPenalty ( D + E ) (3) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,295.48 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 2,295.48 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; ........................................................................... [] [] b, retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without 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 of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and be ef it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of wh ch preparer has any knowledge. SIGNATURE .QF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 783 Old Quaker Road Lewisberr7 ~ PA 17339 ADDRESS 2331 Mark~t-S~eet Camp Hill PA 17011 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 3% [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 0% [72 P.S. §9116 (a) (1.1) (ii)]. 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 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 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 parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) SCHEDULE E BANK & MISC. COMMONWEALTH OF PENNSYLVANIA U/~II! UI:::I"U~I/~, iNHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAM[~R . LOUISE a. 21 94 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MetLife Annuity 26,129.58 Contract Number 078 380 335 AB 2. MetLife Annuity 22,359.94 Contract Number 078 380 333 AB 3. MetLife Annuity 81,194.26 Contract Number 550006832 4. MetLife Annuity 16,977.95 Contract Number 078 380 545 AB 5. Waterhouse Institutional Services 29,095.78 Account Number 503-66056-1-5 6. Fulton Bank 9,009.33 Burial Reserve Account # 101-0069290 TOTAL (Also enter on line 5, Recapitulation) $ 184,766.84 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-,98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAM ~.y,:. LOUISE A. gl 0'~ (H;~> 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. KAREN BERTOLETTE 783 Old Quaker Road Daughter Lewisberry, PA 17339 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTERES' 1. A. 2001 Waterhouse Institutional Services 35,618.58 50. 17,809.29 Account Number 503-66057-1-4 2 A. 2001 Waterhouse Institutional Services 109,116.78 50. 54,558.39 Account Number 503-66058-1-3 3. A 2001 The Flex-Funds 30,418.22 50. 15,209.11 Account Number 31702-00-77 4. A 1998 Pennsylvania State Bank 7,005.55 50. 3,502.78 Certificate of Deposit 40049 5. A 1994 ;Pennsylvania State Bank 37,460.66 50. 18,730.33 Checking Account # 10010486 6. A 1994 Pennsylvania State Bank 5,750.24 50. 2,875.12 Checking Account # 26008219 7. A 2000 ATEL Capital Equipment 14,699.82 50. 7,349.91 Account # 195-07-5550 TOTAL (Also enter on line 6, Recapitulation) $ 120,034.93 (If more space is needed, insert additional sheets of the same size) REV-151.0 EX + (6-~98) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAMF'i~ ~ LOUISE A. 21 Q4 Q4;~Q 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 INCLUDETHE NAME OFTHE YRANSFEREF, THEIR RELATIONSHIP TO DECEDENTANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATT.N::H A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. IRREVOCALBE TRUST 72,422.60 0. M&T BANK INVESTMENT GROUP, TRUSTEE SEE ATTACHED TRUST AGREEMENT TOTAL (Aisc enter on line 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1511 E,X + (12;99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAM, g~. , LOUISE A. 21 04 04~0 Debts of decedent must be reported on Schedule I. iTEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. JOHN E. NEUMYER FUNERAL HOME, INC. 9,039.19 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State . Zip Year(s) Commission Paid: 2. AttomeyFees REAGER & ADLER, P.C. 3,500.00 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. Tax Retum Preparer's Fees R. WM. WIRE, ASSOCIATES, P.C. 1,120.00 2003 TAX RETURNS 7. TOTAL (Also enter on line 9, Recapitulation) $ 13,659.19 (If more space is needed, insert additional sheets of the same size) REV-151'~ E~ + (6-§8) SCHEDULE I DEBTS OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER SCHWINGHAM! F,~ . LOUISE A. 21 Q~. Q4:~Q Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Messiah Village - final payment 6,798.59 TOTAL (Also enter on line 10, Recapitulation) $ 6,798.59 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWIN -~HAM' EI~, LOUISE A. 21 04 0430 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 ~c~U. dg~t~)h~lS.2P~usaldistributions, and transfers under 1. KAREN BERTOLETTE Daughter 100% of estate 783 Old Quaker Road Lewisberry, PA 17339 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) CUmL ,,~ .~ounty, Pennsylvania INVENTORY Estate of SCHWlNGHAMI F.R, LOUISE A. No. 21 04 0430 also known as. Date of Death 2/3/04 , Deceased Social Security No. 195075550 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Attorney: DAVID W. REAGER , . ~_. ,~ ~ I.D. No.: 20868 Address: 2331 MARKET STREET Dated ~/~::::~///~/ / / CAMP HILL PA 17011 / Telephone: 7170763-1383 Description Value Stocks & Bonds ' :~' ~-~ C_ Closely-Held Corporation, Partnership or Sole-Proprietorship r Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property MetLife Annuity 26,129.58 Contract Number 078 380 335 AB MetLife Annuity 22,359.94 Contract Number 078 380 333 AB Total (Attach Additional Sheets if necessary) 184,766.84 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory SCHWINGHAM' ~;]~ , LOUISE A. 21 04 0430 Pa,qe 1 Description of Inventory Description Value MetLife Annuity 81,194.26 Contract Number 550006832 MetLife Annuity 16,977.95 Contract Number 078 380 545 AB Waterhouse Institutional Services 29,095.78 Account Number 503-66056-1-5 Fulton Bank 9,009.33 Burial Reserve Account # 101-0069290 Real Estate Subtotal $ 136,277.32 Grand Total $ 184,766.84 Glenda Farner Strasbaugh ~ Register of Wills & Clerk of the Orphans' Court One Courthouse Square Marjorie A. Wevodau Carlisle, Pa. 17013 First Deputy (717) 240-6345 Kirk S. Sohonage, Esquire FAX (717) 240-7797 Solicitor OFFICES OF · egi~ter of t~lill~ anb tglerl~ of toe ®~ban~' tgourt tgountp of tgun~erlan~ TO: David W. Reager, Esquire 2331 Market Street Camp Hill, PA 17011 ESTATE OF: Louise A. Schwinghamer, 21-04-430. IN RE: Additional Probate Date: July 15th, 2004 The Probate fees on the above estate are $ 235.00. We have received $ 60.00 of that amount. Please remit the balance due of $175.00to the attention of Sue. Thank you RECEIPT FOR PAYMENT Cumberland_County - Register Of Wills Receipt Date: 9/30/2004 Hanover and Hiqh Street Receipt Time: 12:33:29 Carlisle, PA I7013 Receipt No.: 1037967 SCHWINGHAMER LOUISE Paid By Remar~ RE~GER &.ADLER ) ........................ Receipt Distribution ........................ Fee/Tax Description Payment Amount Payee Name SUPP IN-H TAX RETUR 15.00 CUMBERLAND COUNTY GENERAL FUN Cash ~15.00 Total Received ......... 15 00 CUMBERLAND COUNTY REGISTER OF WILLS AND CLERK OF THE OPHANS' COURT FACSIMILE TRANSMITTAL SHEET FROM: Brooke Susana Koser COMPANY: DATE: Reager & Adler Law Firm 9/22/2004 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 717 909-4939 2 PHONE NUMBER: SENDER'S REFERENCE NUMBER: RE: YOUR REFERENCE NUMBER: Additional Probate Fee sk [] URGENT [] FOR REVIEW [] PLEASE COMMENT [] PLEASE REPLY [] PLEASE RECYCLE NOTES/COMMENTS: Brooke, I am faxing a copy of the bill for Additional Probate for the Estate of Louise A. Schwinghamer, Estate No: 21-2004-430. I had spoken with Joanne about this matter and was told to check with you. Please give me a call, the phone number is (717) 240 -5340 and ask for Sue. Thank you very much. Sue REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER SUSAN H. CONFAIR CHARLES E. ZALESKI JOANNE HARRISON CLOUGH LINUS E. FENICLE THOMAS J. ROZMAN DEBRA DENISON CANTOR TIFFANY M. CARTWRIGHT THOMAS O. WILLIAMS PETER R. WILSON SUSAN J. SMITH +Certified Civil Trial Specialist Writer's E-Mail Address: MZercher@ReagerAdlerPC.com September 30, 2004 Via Hand Delivery Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Louise A. Schwinghamer Estate No. 21-2004-430 Our File No. 86-245.002 To Whom It May Concern: Enclosed please find a Supplemental Inheritance Tax Return for the Estate of Louise A. Schwinghamer. Please file the original with your office and time-stamp the additional copies to be returned with our courier. Thank you for your cooperation in this matter. Please feel free to contact me in the event you have any questions. Very truly yours, Enclosures 89/29/2884 15:12 7179894939 REAGER & ADLER PC PAGE 81 ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET ~;~Z~ CAMP HILL. PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.c. om THEODORE A. ADLER + SUSAN H. CONFA~.R DAVID W. REAGER JEANNE HARRISON CLOUGH CHARLES E. 'ZALESKI THOMAS J. ROZMAN LINUS E. FENICLE TIFFANY M. CARTWRIGHT DEBRA DENISON CANTOR PETER R. WILSON THOMAS O. WILLIAMS SUSAN J. SMITH +Certified Civil Trial Specialist FACS/MILE C( ) VE,R SHEET, IIIII .... . II .. I Date; September 29, 2004 To: Susans Koser From: Brooke Bu~'~on Fax No,; 717-240- 779 7 Same to Follow by Mail: Yes Page(si to Follow: 8 . I III .. ~al . I . III Message: P/ease see attached Supplemental inheritance Tax Return for the Estate of Louise Schwinghamer. ' Original will follow via hand delivery on September 30e, Thank P/ease cell Brooke at (7 f ?~ 763-1383 Ext. 121 ff there is any problem in transmission. The information ~o~ltelned in thi~ telefec~'n~Te is transmitted by an attorney. It is privileged end confi~ee#el, intended only for the use of the individual or ~tity nsmed above, ff the reader of this message is not the intended recipient, you are hereby no#fie~ that any dissemlnstlon, EistribuHon Or Copying of this communication i$ $tn'etly prohibited. If this communicaEon has the above addre-~ via the U.S, Posts! Servi~e (we will reimburse Ioo~tege), Thank you. 09/29/2004 15:12 7179094939 REAGER & ADLER PC PAGE 02 PENNSYt.VANI~ ~'~'~'"~' RESIDENT DECEDENT ~ ~ - o~ o ~ ~ o ~qHWING~ER 9 4-0 7-5 5 5 0 D W. R~GER I 2331 ~RK~ STREET R~GER & ~LER, P.~ 4.~&~~(~D) (4) .. S.~,~~&~~p~ (S) ...... 29,~5.78 (~) (19) ..... 12,795.~ T~ 09/29/2004 15:12 ?179094~39 REAGER & ADLER PO PAGE 03 Dm:edmtt'~ Complet~ Addreee: T~ Pa~ and C~: T~(A+e.C) (2) 10,500.~ D. ~ T~~~(O+E) (3) .... A. ~ ~ ~em ~e, (~) ,., Make ~ Paya~e to: ~GISTER OF ~S, AGENT ~E ~~ ~E FOLLO~ QUE~S BY P~CI~ ~ '~ IN THE ~~TE BL~ 1. ~~~~: Y~ No ~ISBERRY C~P HILL .... PA 17011 09/29/2004 l§: 12 7179094939 REAGER & ADLER PO PAGE 04 SCHEDULE E ~T'~V~ CASH, ~NK DEPOSITS, & MISC. ~T~ ~~ PERSON~ PROPER~ )~ ...... ~UE ~T ~ TE ,, ~ ~R~ION OF ~nt NumW TOTAL (Al~o e~tM on line $, Recap#ulMon) $ 29.095.7~1 (ff mom qaace i~ Me~e;I, inw~a(J~Jonal she~ of~'teMmeslze) 09/29/2004 15:12 7179094939 REAGER & ADLER PO PAGE 05 SCHEDULE F =ouuo,,~, o~ ~-~e~v,~ JOINTLY-OWNED PROPERTY INH~I~rANCE TAX I~rul~ SCI"IVVINGHAMER _ 21 , 04 0A;J0 . A. Kamn Beftolette 783 Old Quaker Road Daughter Lewi~bed~, PA 17339 B C 09/29/2004 1S:12 7179094939 REAGER & ADLER PO PAGE 06 SCHEDULE O INTER. VIVOS TRANSFERS & C(~,~IOJW~MJ. TH ~ ~V~ ~ r~ ~ MI~. ~N-PRO~TE PROP~ ~ Num~ 078 ~0 33~ ~ ~t~ Number ~~ 09/29/2004 15:12 7179094~39 REAGER & ADLER PO PAGE ~ I SCHEDULE H ~B~ OESC~ION 6, Ta.R~.m~r-~ R. WM. Wire, Associates, P.C. 1,120.00 2003 Tax Returns 7, TOTAL (AI~o enter off line 9, Rec~ffiu~) $ 13,1~1g ' ' (If m~e ~ce is need~; Inse~t ~ldiUon~l ~eet~ of the r,~me dze) 09/29/2004 15:12 ?179094939 REAGER & ADLER PO PAGE 00 ~=~v~ DE~8 OF DECEDENT, ~~ ~RTGAGE L~BILffi;~, & UEN8 NUM~ ~SCffi~l~ A~U~ TOTAL (ALeo er~er on ~e 1.0, _ _ ~ .Rm~ejI,ation) $ needed, inee~t eddit~a~ iheets ot the ~me 89/29/2884 15:12 7179894939 REAGER & ADLER PO PAGE 09 SCHEDULE J ~~ ~ P~v~ BENEFICES SCH~N ~ER 21 ~ ~ ~T~P TO ~ ~ ~ ~ N~ ~ ~ ~ ~ ~S) ~l~O ~ ~,~. ~ T~} ~ ~ATE 1, ~ ~e ~ughmr 1~% of ~ 7~ Old ~ ~ L~~, PA J~ ,,,ENTER OOM.AR AMOUNTS FOR ~ SHOWN ABOVE ON UNES 15 THROUC-.-~ t8. AG ~TE, ON REV-I,~O COVER ~ ,'~,.,.~ Ii[.' NO~T~ F~i i~UT~iN~' Illl , .... .4.. ~ DIS'I"REIUTIONS UNDER SECTION 9113 FOR WHICH AN ELEC'rlON TO TAX I$ NOT BEING MA~E 1, B. CH/~T/18LE ~ GO--AL DISTRIBUTIONS 1. ¥OYAI. OF P.N~I' II - ENTER TOTN. NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV. IS00 ~R ~ $ ' ' (If mc~--q~ Is needed, II~eff aJdi~ shee~ of Itle same aim) ........ · ' Marjorie A. Wevodau First Glenda Farner Strasbaugh Deputy Register of Wills and Clerk of Orphans' Court Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE I Bill To: InvoiceNo: 11 Reager & Adler, PC Invoice Date: 09/22/04 Estate off Louise A. Schwinghamer 2331 Market Street Estate No: 21-03-0430 Camp Hill, PA 17011- Qt~ Fee Description Fee Total I Additional Probate 175.00 $175.00 Total: $175.00 Checks should be made payable to the Register o ~ /~ ~_62~ Please return °ne c°py °f this rev°ice with y°ur paymer( ?/2~(~Z~h,~f~ ¢, : REV-1500 EX + (6-00) REV-1500 PENNSYLVANIA OEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 RESIDENT DECEDENT 2 0 3 0 DE~DENT'S NAME (~ST, FIRST AND MIDDLE INiTiAL SOCIAL SECURI~ NUMBER SC,~WINGHAMER ~0~1~ ~- 1 9 4- 0 7- 5 5 5 0 DATE OF DEATH (MM-DD-Year} ~ DATE OF BIRTH (UM-D~Year) THIS RETURN MUST BE FILED IN DUPLICATE WEH THE I 02/03/2004 07/20/1917 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCrAL SECURI~ NUMBER - _ ~ 1. Odginal Return ~ 2. Supplemen~l Retum ~ 3. Remainder Retum (daeof~ pdorto 12-1~82) ~ 4. Limited Es~te I ~ 4a. Future Interest Compromise (d~ ordea~ ~er 12-12-82) ~ 5. Federal Es~te Tax Return Required I ~ 6. Decedent Died Tes~te (A~h copy of Wi,,) ~ 7. Decedent Maintained a Living Trust (A~h copy of Trust) ~ 8. TO~I Number of Safe Deposit Boxes ~ 9. Lit~ation Premeds Remived ~ 10. Spousal Pove~ Credit (da~ of dea~ ~n 12-31-91 and 1-1-95) ~ 11. Die,ion to ~x under Sec. 9113(A) (A~h Sch O) THIS SECTION MUST BE COMPL~ leu; AEL CORRESPONDENCE AND CONFIDENTIAL T~ INFORMATION;SHOULD BE;DIRECTED TO: NAME COMPLETE MAILING ADDRESS DAVID W. REAGER 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER~ P.C. TELEPHONE NUMBER 717763-1383 CAMP HILL PA 17011 1. Real Es~te (Schedule A) (1) OFFICIAL USE ONLY 2. Stocks and Bonds (Sch~ule B) (2) ~; ~ 3. Closely Held Co~oration, Pa~emhip or Sole-Pmpdetomhip (3) ~:.~ 4. Modgages & Not~ Remivable (Schedule D) (4) I 5. Cash, Bank De~si~ & Mis~llan~us Pemonal Pmpe~ (5) 29i095.78 (Schedule E) 6. Jointly ~ned Pmpe~ (Sch~ule F) (6) 120,034.93 ~ Separate Billing Requ~t~ 6 .061r 7. Inter-Vivos Tmnsfem & Mis~llaneous Non-Probate Prope~ (7) 155, 71 (Sch~ule G or L) 8. To~l Gross Assets (total Lines 1-7) (8) 304~801.77 9. Funeral Expenses & Adminis~ve Cos~ (Schedule H) (9) 13~659.19 10. Deb~ of D~dent, Mo~gage Liabilities, & Liens (Schedule I) (10) 6~ 798.59 11. To~I Deductions (to~l Lines 9 & 10) (11) 20~457.78 12. Net Value of Es~te (Line 8 minus Line 11) (12) 284~343.99 13. Chafi~ble and Govemmen~l Bequest/Sec 9113 Tms~ for which an ele~ion to tax has not been (13) made (S~edule J) 14. Net Value Subje~ to Tax (Line 12 minus Line 13) (14) 284~343.99 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE ~TES 15. Amount of Line 14 taxable at ~e spousal ~x rate, or transfem under Sec. 9116 (a)(1.2) X ~ (15) 16. Amount of Line14 ~xable at lineal rate 284~343.99 x .045 (16) 12~795.48 17. Amount of Line 14 taxable at sibling rote X .~2 18. Amount of Line 14 ~xable at ~llateral rate X .~5 (18) 19. Tax Due (~9) 12,795.48 20. >> BE;SURE TO ANSWER AEE QUESTIONS ON RE~ERSE;SlDEAND RECHECK~ < Decedent's Complete Address: STREET ADDRESS MESSIAH VILLAGE NURSING HOME CITY GRANTHAM I STATE PA IZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 12,795.48 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 10,000.00 C. Discount 500.00 Total Credits ( A + B + C ) (2) 10~500.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestJPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 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) 2,295.48 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 2~295.48 Make Check Payable to: REGISTER OF WILLS, AGENT ii ; PLEASE ANSWER THE FOLLOWING BY PLACING AN "X" IN THE AppROpRIATE BLOcKs QUESTIONS 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 income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on? 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 SCHEBULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pedury, I declare that I have examined th s return including accompanying schedules and statements and to the best of my knowledge and belief, it is true, correct and complete. Dectaration of preparer other than the persona representative is based on all information of wh ch preparer has any knowledge. SIGNATURE OF PERSON RESP. ONSIBLE FOR FILING RETURN . ADDRESS 783 OLD QUAKER ROAD LEWISBERRY SIGNATURE OF PREPARER OTZ TH~,~SENTATiVE PA i~E~9 ADDRESS 2331 MARKE'-F.-R/E~ O'~ Xl~ CAMP HILL PA 17011 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 3% [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 0% [72 P.S. {}9116 (a) (1.1) (ii)]. 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 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 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 parent in common with the decedent, whether by blood or adoption. RE-~/-1508 EX + {1-97) ~ SCHEDULE E COMMONW~,TH~OF PENNS¥'VAN,ACASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FlEE NUMBER SCHWINGHAMI~R ;~1 04 04;~Q Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Waterhouse Institutional Services 29,095.78 Account Number 503-66056-1-5 TOTAL (Also enter on line 5, Recapitulation) i $ 29r095.78 (If more space is needed, insert additional sheets of the same size) REV-15~9 EX + (1-97} ~ , SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAMER 21 04 0430 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. Karen Bertolette 783 Old Quaker Road Daughter Lewisberry, PA 17339 JOINTLY-OWNED PROPERTY: U- ~ I ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-beld real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 2001 Waterhouse Institutional Services 35,618.58 50. 17,809.2~ Account Number 503-66057-1-4 2. A. 2001 Waterhouse Institutional Services 109,116.78 50. 54,558.39 Account Number 503-66058-1-3 3. A. 2001 The Flex-Funds 30,418.22 50. 15,209.11 Account Number 31702-00-77 4. A. 1998 Pennsylvania State Bank 7,005.55 50. 3,502.78 Certificate of Deposit 40049 5. A. 1994 Pennsylvania State Bank 37,460.66 50. 18,730.33 Checking Account Number 10010486 6. A. 1994 Pennsylvania State Bank 5,750.24 50. 2,875.12 Checking Account Number 26008219 7. A. 2000 ATEL Capital Equipment 14,699.82 50. 7,349.91 Account Number 195-07-5550 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 120,034.93 REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAMER 21 04 0430 This schedule must be completed and tiled if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET ~s les. DESCRIPTION OF PROPERTY % OF ITEM INCLUDETHE NAMEOFTHETRANSFEREE, THEIRRELATIONSHIPTODECEDENTANDTHEDATEOFTRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE 1. Irrevocable Trust 72,422.60 O. 'M&T Bank Investment Group, Trustee See Attached Trust Agreement 2. MetLife Annuity 26,129.58 100. 26,129.5E Contract Number 078 380 335 AB 3. MetLife Annuity 22,359.94 100. 22,359.94 Contract Number 078 380 333 AB 4. MetLife Annuity 81,194.26 100. 81,194.26 Contract Number 550006832 5. MetLife Annuity 16,977.95 100. 16,977.95 Contract Number 078 380 545 AB 6. Fulton Bank 9,009.33 100. 9,009.33 Burial Reserve Account Number 101-0069290 TOTAL (Also enter on line 7, Recapitulation) $ 155,671. ~pace ~s ., insert additional sheets of the same size) REV-1511EX + (1-97) SCHEBULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES& INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVECOSTS ESTATE OF FILE NUMBER SCHWINGHAMER 21 04 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. John E. Neumyer Funeral Home, Inc. 9,039.19 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttomeyFees Reager & Adler, P.C. 3,500.00 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. Tax Return Preparer's Fees R. WM. Wire, Associates, P.C. 2003 Tax Returns 1,120.00 7. TOTAL (Also enter on line 9, Recapitulation) $ 13,659.19 (If more space is needed, insert additional sheets of the same size) SCHEDULE I CO'"MO~'WEALTH OFPENNSYLVA~,IA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RES,OEN'r[~ECEDEN'r MORTGAGE LIABILITIES~ & LIENS ESTATE OF FILE NUMBER SCHWINGHAMER 21 04 0430 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Messiah Village - Final payment 6,798.59 TOTAL (Also enter on line 10, Recapitulation) $ 6~798.59 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-nn~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SCHWINGHAMER 21 04 0430 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Bo Not List Trustee(s) OF ESTATE [. TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 9116 (a)(1.2)] ' 1. Karen Bertolette Daughter 100% of Estate 783 Old Quaker Road Lewisberry, PA 17339 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXAI~LE 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Louise A. Schwinghamer Date of Death: February 3, 2004 Will No. 2104-0430 To the Register: I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 7, 2004. Name Address Karen A. Bertolette 783 Old Quaker Road Lewisberry, PA 17339 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A Date: October ~ , 2004 David W. Reager, ]~squire' Reager & Adler, PC~ 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal l~epre~tativ~; Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 REAGER DAVID W ESQ 2331 MARKET ST CAMP HILL, PA 17011 RE: Estate of SCHWINGHA~4ER LOUISE File Number: 2004-00430 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPH3~NS, COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans, Court his/her Certification of Notice. This filing will become delinquent on 10/09/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, cc: File Personal Representative(s) Judge Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 10/05/2004 BERTOLETTE KAREN A 783 OLD QUAKER LEWISBERRY, PA 17339 RE: Estate of SCHWINGHAMER LOUISE File Number: 2004-00430 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 10/09/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER Clerk of the Orphans' Court cc: File Counsel Judge c~ .?~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITAXCE TAX D/V/SION ~EPT. HARRISBURG, PA 17118-060! NOTICE OF /NHERITANCE TAX APPRA/SEMENT, ALLOHANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-l$47EX&FP(01-,$) DATE 10-25-200q ESTATE OF SCHWZNGHAMER LOUISE A DATE OF DEATH 02-05-200q FILE NUHBER 11 0R-0~50 COUNTY CUMBERLAND DAVID W REAGER *0~ F~'T 2~ -" ACN 101 2331 MARKET ST ] Amount Remitted CAMP H~LL ~,rR 170~! HAKE 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 REV-1547 EX AFP ~01-03) NOTICE OF XNHERXTANCE TAX APPRAXSEMENT; ALLOWANCE OR DXSALLOWANCE OF DEDUCTXONS AND ASSESSMENT OF TAX ESTATE OF SCHWINGHAMER LOUISE AFXLE NO. 110q-Oq50 ACM 101 DATE 10-25-200q TAX RETURN NAS: { ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATXON CONCERNXNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEMENTAL RETURN NO. 1. Real Es~a~e (Schedule A) {1) .00 NOTE: To insure proper 2. S~ocks and Bonds {Schedule B) (2) .00 credi~ ~o your accoun~ $. Closely Held S~ock/Par~nership In~ares~ {Schedule C) {$) .00 subei~ ~ha upper portion q. Mortgages~No,es Receivable (Schedule D) (q) .00 of ~his form wi~h your $. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (5) 29 z 095.78 ~ax payment. 6. Jointly Owned Proper~y (Schedule F) (6) 110 I 05q. 93 7. Transfers (Schedule G) (7) 155z671.06 8. To,al Asse~s (8) 50q,801.77 APPROVED DEDUCTIONS AND EXEMPTIONS: ~5,6S9.~9 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9) 10. Dab~s/Mor~gage Liabili~ies/Lians (Schedule 1) (10) 6~798.59 11. To,al Deductions (11) 2~.~57.78 12. Ne~ Value of Tax Re~urn (12) Z8q,SqS.99 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 lq. Na~ Value of Es~a~e Sub~ec~ ~o Tax (lq) 28q,Sq$.99 NOTE: I~ an assessment ~as lssued previously, 11nas la, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 1E. Aeoun~ of Line lq at Spousal ra*e (15) .00 X O0 = .00 16. Aaoun~ of Line lq ~axable a~ Lineal/Class A ra~e (16) 28q,SqS.99 X Oq5 = 1Z,795.q8 17. Amoun~ of Line lq a~ Sibling ra~e (17) .00 X ~2 = .00 18. Amoun~ of L/ne lq ~axable a~ Collateral/Class B ra~e (18) .00 X ~5 = .00 19. Principal Tax Due (19)= 1Z,795.q8 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-05-Z00q CD005897 526.32 10,000.00 07-15-200q CO00q162 .00 Z,Z95.q8 TOTAL TAX CREDIT I 11,821.80 BALANCE OF TAX DuEl 26.52CR INTEREST AND PEN. .00 TOTAL DUE 26.3ZCR TF PAID AFTER DATE INDICATED, SEE REVERSE ( TF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ' FOR CALCULATION OF ADDTTIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTTONS. RESERVATION: Estates of decedents dying on or before Decamber iZ, 198Z -- if any future intarest in the estate is transfarrad in possession ar enjoyment to Class B (collateral) beneficiaries of the decedent after fha expiration of any estate for Iifa or for years, the CammonaaaLth hereby expressly reserves tho right to appraise and assess transfer Inharitanca Taxes at the Iawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fuXfilX the requiremants of Section Zi40 of tha Xnheritanca and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 9140). PAYNENT: Detach the tap portion of this Notica and submit with your payment to the Ragistsr of Hills printed on the ravarse sida. --Hake check or money ordar payable to: REGISTER OF NILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requasted on the Tax Return, may ba requastad by completing an "Application for Rafund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications are availabla at tha Office of tha Registar of Hills, any of tha 25 Ravonua District Officas, or by calling the special 24-hour answaring sarvica for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and ! or speaking needs: 1-800-447-50Z0 (TT only). OBJECTIONS: Any party in intarest not satisfied aith the appraisement, allowanca, or disallowancm of deductions, ar assessment of tax [including discount or interest) as shown on this Notice must object within sixty (60) days of recaipt of this Notice by: --written protest to tha PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-10Z1, OR --election to have the matter determined at audit of the account of tho personal representative, OR --appeal to the Orphans' Court. ADNIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addrassed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assasseent Raviea Unit, Dept. Z80601, Harrisburg, PA 171ZB-0601 Phone (7173 767-6505. See page S of tha booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an axplanation of administrativaly correctabla errors. DISCOUNT: If any tax due is paid within three ($) calendar months altar the dacadent's death, a five percent (SI) discount of tha tax paid is alloaed. PENALTY: The 15X tax amnesty non-participation panalty is computed on the total of the tax and interest assessed, and not paid ba~ore January lB, 1996, tha first day after tha and of the tax amnesty pariod. This non-participation panalty is appaalabla in tha same manner and in tho tho same tiaa period as you would appaal the tax and interast that has been assessed as indicatad on this notice. INTEREST: Intarast is charged beginning with first day of delinquancy, ar nine (9) months and Dna (1) day from the date of death, to the date of paymant. Taxes which became dalinquant before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by tha PA Oapartmant of Revenue. Tho applicable interest rates for 198Z through ZOO4 ara: Interest Daily Interast Daily Intarest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .000548 1988-1991 llZ .000~01 2001 9Z .000Z47 1983 162 .000438 199Z 9Z .000247 200Z 62 .000164 1984 llX .000501 1995-1994 7Z .O0019Z 2003 5Z .000137 1985 1SI .000S56 1995-1998 9Z .000247 2004 4Z .000110 1986 lOX .000274 1999 ?Z .O0019Z 1987 IOZ .O00Z?4 ZOO0 7Z .O00Zgz --Intorast is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issuad after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. REV-1470 EX (6-88~) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURGI PA 17128-0601 DECEDENT'S NAME FILE NUMBER Louise A Scwinghamer 2104-0430 REVIEWED BY ACN Sandra J Eslinger 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Accepted revised return. ROW Page 1 COHNON#EALTH OF PENNSYLVANTA DEPARTHENT OF REVENUE BUREAU OF TNDTVTDUAL TAXES TNHERTTANCE TAX /NHERTTANCE TAX DZYTSTON po 8ox z8O6Ol STATEHENT OF ACCOUNT HARR/SBURG, PA 17128-0601 REV-i&07 EX AFP C09-0¢) DATE 11-22-200~ ESTATE OF SCHWINGHAMER LOUISE A DATE OF DEATH 02-05-200~ FILE NUMBER 21 0~-0~$0 COUNTY CUMBERLAND DAVID W REAGER ACN 101 2551 HARKET ST CA~ HILL PA 17011 Amoun~ Remi~ed 0oo k_6D' -- ~C~ MAKE CHECK PAYABLE AND REHZT PAYHENT TO: ©C> REGISTER OF WILLS LLJ t,~L~:, __ I! ~Z "~' CUMBERLAND CO COURT HOUSE ~E: ~insure~ar credi* *o your account, ,ubmi~ ~h, upper portion of ~his form wi~h your ~,x C~LON~y2S k2~' ..~ .... ~TAZN LONER PORTZON FOR YOUR RECORDS ~ ~~ ~W ~- ~ NNN ~~~'~~'~'X~O~''~ ..................... ESTATE OF SCHWINGHAMER LOUISE A FTLE NO. 21 0~-0~$0 ACN 101 DATE 11-22-200~ THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHOWN BELOW ZSA SUHNARY OF THE PRZNCTpAL TAX DUE, APPLTCATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED TNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-18-200~ PRINCIPAL TAX DUE: .................................................................................... 12,795.~8 PAYMENTS (TAX CREDITS): PAYHENT RECEIPT DISCOUNT ¢+) DATE NUMBER INTEREST/PEN PAID ¢- AMOUNT PAID 05-05-200~ CD005897 526.52 10,000.00 07-15-200~ CDOOR162 .00 2,295.~8 11-08-200~ REFUND ~ ~ .00 26.52- TOTAL TAX CREDTT 12,795.~8 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE . 00 SIDE FOR CALCULATION OF ADDITIONAL TNTEREST. ZF TOTAL DUE ZS LESS THAN 91, NO PAYHENT ZS REi~UTRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR ZNSTRUCT/ONS. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Louise A. Schwinghamer Date of Death: February_ 3, 2004 File No.: 21 04-0430 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: C. Did the personal representative state an account informally to the parties in interest? Yes X No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. David W Reager, Esquire Reager & Adler, P.C. 2331 M~ket Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative