HomeMy WebLinkAbout01-29-10 (3)1505607120
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 5 5 5
PO 60X.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
049 22 5833 04 02 2009 08 07 1918
Decedent's Last Name Suffix Decedent's First Name MI
SWEIGART PAULINE M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
i X~ 1. Original Return ~ 2. Supplemental Return ~~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~ _ ~, 5. Federal Estate Tax Return Required
(date of death after 12-1282)
', X g Decedent Died restate ~
-- (Attach Copy of wily ~, Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
9. Litigation Proceeds Received 1p.'Spousal Poverty Credit ((date of death f ~ 11.Election to tax under Sec. 9113(A)
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12
31
91
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-' (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
AMY M. MOYA 717 652 7323
Firm Name (If Applicable)
L.O. OF SUSAN E. LEDERER
First line of address
5011 LOCUST LANE
Second line of address
City or Post Office State ZIP Code
HARRISBURG PA 17109
REGISTER @1_= BLS USF~QNLY
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Correspondent'se-mail address: Amy@Ledererlaw.com
Under penalties of perjury, I declare that 1 have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, corcmrylat~ Declaration of preparer other than the personal) representative is based on all information of which preparer has any knowledge.
au.Q- ~°'~m.Q~...~2~-~" Jane Raber
411
SIGNA
Camp Hill, PA 17011
'HER THAN REPRESENTATIVE
Amy M. Moya
/~~s~/6
5011 Locust Lane, Harrisburg, PA 17109
Side 1
1505607120
~ la's/i
1505607120 J
~~~~
PA Inheritance Tax Return
Signature of Additional Fiduciaries
I ESTATE OF I FILE NUMBER I
Sweigart, Pauline M 21-09-0555
I Under penalties of perjury, I deGare that I have examined this, including accompanying schedules and statements, and to the best of my I
knowledge and belief, it is true, correct and complete. Declar n f preparer other than the personal representative is based on all information
of which preparer has any knp~ig~. ~ ~ A
Signature #2
Name
Address1
Address2
City, State, Zip
Rodrick Richard Swei~
Date
1062 Jacks Mountain Road
Mc Veytown, PA 17051
~ sCln
r
REV-1500 EX
oeceaenrs Name: P a u l i n e M S w e i g a rt
Decedent's Social Security Number
049 22 5833
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... 1.
2. Stocks and Bonds (Schedule B) ........................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) ..............................._....................... . 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... . 5.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) .............................__...........................__..... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9.
10. Oebts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. .. 10.
11. Total Deductions (total Lines 9 & 10) .............................._............................_..... 11.
12. Net Value of Estate (Line 8-minus Line 11) .............................._......................... . 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .............................................. 13,
14. Net Value Subject to Tax (Line 12 minus Line 13) ............................. ................. 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 0 0 0 15.
16. Amount of Line 14 taxable
0
0 0
16
.
at lineal rate X .045 .
17. Amount of Line 14 taxable
0 0 0
at sibling rate X .12 17.
18. Amount of Line 14 taxable 4 0 9
9 3 7
1 4 18
,
.
at collateral rate X .15 .
19. Tax Due ............................................................_.............................__................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505607220
289,346.79
75,153.27
87,575.79
452,075.85
31,042.64
11,096.07
42,138.71
409,937.14
409,937.14
0.00
0.00
0.00
61,490.57
61,490.57
Side 2
1505607220 1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0555
DECEDENTS NAME
Pauline M Sweigart
_--
STREET ADDRESS
4837 E Trindle Road, Apt. 107
CITY Si ATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p. Interest
E. Penalty
0.87
Total Credits (A + B + C)
Total InteresUPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + line 3 is greater than Line 2, enter the difference. This is theTAX DUE
A. Enter the interest on the tax due.
B. Enter the-total of Line 5 + 5A. This is theBALANCE DUE
(1) 61,490.57
(2) 61,197.37
(3) 0.87
(a)
(5) 294.07
(5A)
(56) 294.07
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 prope-ty transferred :............................................................................. n '~
__
9 9 p party transferred or its income :................................
-~
ry ' ', xl
-~
d. race ve thversimise for Iffe of a theralla ments benefits or care?............••.•...•.•.•....•• ........--....•~.~~••..••. ~ x
P ~ P Y ............................................ ~ x~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................................................................................................ f ~ z ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ' ~ x'~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................................................................................................................ I x' __
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
__ _
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one•half (4.5) percent,
except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
59,250.00
1,947.37
Rev-1503 r:x+ (B-98)
SCHEDULE B
STOCKS ~ BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Sweigart, Pauline M 21-09-0555
All property jointly-owned with right of survivorship must tre disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 30161N101 336 share of Exelon Corp -held at Morgan Stanley, 46.67 15.681.12
Account No. 410 018185140, titled to Pauline M.
Sweigart ($46.67/share)
2 302316102 922 shares of Exxon Mobil Corp -held at Morgan 70.425 64,931.85
Stanley, Account No. 410 018185140, titled to Pauline
M. Sweigart ($70.425/share)
3 e2oso22o2 1,645.557 units of Van Kampen PA Tax Free Inc B - 14.20 23,366.91.
held at Morgan Stanley; Account No. 410 018185140,
titled to Pauline M. Sweigart ($14.20/NAV) ,
4 , _ 723682100 1,040.766 units of Pioneer Fund A -held at Morgan 26.93 28,027.83
Stanley, Account No. 410 018185140, titled to Pauline
M. Sweigart ($26.93/NAV)
5 920902103 11,033.596 units of Van Kampen PA Tax Free Inc A - 14.26 157,339.08
held at Morgan Stanley, Account No. 410 018185140,
titled to Pauline M. Sweigart ($14.26/NAV)
TOTAL (Also enter on Line 2, Recapitulation) 289,346.79
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sweigart, Pauline M 21-09-0555
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Checking Account No. 5140219525 -held at PNC Bank, titled to Pauline M. Sweigart 23,500.54
($1.28 accrued interest)
2 Savings Account No. 5003816331 -held at PNC Bank, titled to Pauline M. Sweigart 32,565.44
($13.20 accrued interest) .
3 Money Market Fund -held at Morgan Stanley, Account No. 410 018185140, titled to 13,125.85
Pauline M. Sweigart
4 Check from Allstate Insurance Company - (refund of renter's insurance policy) 16.00
5 Check from Country Meadows - (refund of rent) 4,586.67
6 Check from U.S. Treasury - (refund of Individual Federal Income Tax) 946.00
7 Check from PA State Employees Retirement System - (final benefit payment) 162.77
8 Personal Property 250.00
TOTAL (Also enter on Line 5, Recapitulation) I 75,153.27
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-7570 EX+ (g_98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF - (FILE NUMBER
Sweigart, Pauline M 21-09-0555
This scf~dule must be completed and filed 'rF the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Hartford Annuity, Policy No. 710684953 -held at 45,179.22 100.000 45.179.22
Morgan Stanley -Pauline M. Sweigart, owner,
(Kimberly Conley, Rodrick Sweigart, Pamela
Sweigart, William Bradley Sweigart, Joseph
Goss, and Sean Sweigart, beneficiaries)
2 Allstate Annuity, Policy No. 358930 -Pauline M. 12,257.70 100.000 12,257.70
Sweigart, owner (Vernon Conley, Megan Conley,
beneficiaries)
3 Allstate Annuity, Policy No. 358932 -Pauline M. 29,298.87 100.000 29.298.87
.Sweigart, owner (Stephen Sweigart, Aaron
Sweigart, beneficiaries)
4 Prepaid cremation services 840.00 100.000 840.00
TOTAL (Also enter on Line 7, Recapitulation) 87,575.79
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 ScheduleG (Rev. 6-98)
REV-1151 EX+(12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Sweigart, Pauline M 21-09-0555
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
1,330.62
B. ADMINISTRATIVE COSTS: . .
1. Personal Representative's Commissions
Jane Raber. Rodrick Richard
Social Security Number(s)1 EIN Number of Personal Representative(s):
Street Address 411 Reeser Road
City Camp Hill State PA Zip 17011
Year(s) Commission paid 22,250.00
2. Attorney's Fees Law Offices of Susan E. Lederer 6,000.00
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 Register of Wills of Cumberland County 375.00
5. Accountant's Fees 95.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 992.02
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 31,042.64
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Sweigart, Pauline M 21-09-0555
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exaenses
1 Auer Cremation Services of Pennsylvania, Inc. 1,250.62
2 Grave marker etching 80.00
H-A subtotal 1,330.62
Other Administrative Costs
3 The Carlisle Sentinel - (estate advertising) :276:02
4 Cumberland Law Journal - (estate advertising) 75.00
5 Cumberland County Register of Wills - (filing fee - PA Inheritance Tax Returrr.and 30.00
Inventory) -
6 Rodrick Richard Sweigart - (mileage reimbursement - 6 roundtrips @ 170 miles each 561.00
.55 per mile)
7 Cumberland County Register of Wills - (additional probate fees) 50.00
H-B7 Subtotal 992.02
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule H (Rev. 6-98)
Rev-1512 EX+(6-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
COMMONWrALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sweigart, Pauline M 21-09-0555
Include unreimbureed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Pharmacy Services, Inc. - (prescription costs) 97.70
2 Country Meadows - (rent payment) 4.716.70
3 Commonwealth of Pennsylvania State Employees' Retirement System - 6,281.67
(reimbursement of overpayment of benefits)
TOTAL (Also enter on Line 10, Recapitulation) I 11,096.07
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-7513 EX+ (8-00)
SCHEDULE J
COM NHENRTAANC
DTAXR
~~ BENEFICIARIES
E
ETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sweigart, Pauline M 21-09-0 555
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trusts s
I TAXABLE DISTRIBUTIONS [include,outright spousal
~ distributions and transfers
under Sec. ~116(a)(1.2)]
See attached schedule
Total 409,937.14
Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVEAt SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98)
SCHEDULE J
The BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Pauline M Sweigart 04/02/2009 049-22-5833
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
7
2
3
Megan Brindle Conley Grand Niece
210 Pinewood Drive
Pasadena, MD 21122
Vernon Keith Conley Jr. Grand Nephew
210 Pinewood Drive
Pasadena, MD 21122
Aaron Jacob Sweigart Grand Nephew
1413 Cambridge Court
Palmyra, PA 17078
Stephen Andrew Sweigart Grand Nephew
1/2 of Allstate annuity 6.128.85
358930
1/2 of Allstate annuity 6,128.85
358930
1/2 of Allstate annuity 14.649.43
358932
4
5
6
7
8
9
10
448 Plane Street
Middletown, PA 17057
Kimberly Sweigart Conley Niece
210 Pinewood Drive
Pasadena, MD 21122
Joseph Harold Goss Nephew
227 Mary Street #5
Harrisburg, PA 17104
Pamela Jo Sweigart (died 8/4/2009) Niece
2314 Harper Street
Santa Cruz, CA 95062
Rodrick Richard Sweigart Nephew
1062 Jacks Mountain Road
Mc Veytown, PA 17051
Sean Christopher Sweigart Nephew
3626 Earlysville Road
Earlysville, VA 22936
Jeanne B. Sweigart, Trustee of the Nephew
William Bradley Sweigart
Testamentary Trust
210 Second Street #8
Belleville, PA 17004
1/2 of Allstate annuity 14,649.44
358932
20% of residue; 20% 76,176.11
of Hartford annuity
10 % of residue; 10% 38,088.06
of Hartford annuity
20% of residue; 20% 76,176.11
of Hartford annuity
20% of residue, 63,676.11
minus $10,000; 20%
of Hartford annuity
10% of residue; 10°~ 38,088.07
of Hartford annuity
20% of residue; 20% 76,176.11
of Hartford annuity
Total 409.937.14
1
Jacky All. Mindeck
From: RV, Inheritance Tax Extension [RA-InheritanceTaxExt@state.pa.us]
Sent: Wednesday, December 30, 2009 2:05 PM
To: 'Jacky M. Mindeck'
Cc: 'gfarner@ccpa.net'
Subject: Pauline Sweigart, Est.
~ - ~3~~1~15~~~/~1"~
l~r4c~al~1•l~laYlu-r ar ~a~v~NU~
The following message is being sent from an unmonitored account. Please do not reply.
Re: Estate of Pauline Sweigart
File Number 2109-0555
Dear Sir or Madam:
This is in response to your request for an extension of time to.fiie the Inheritance Tax Return for the above
estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return
is extended for an additional period of six months: This extension will avoid the imposition of a penalty for
failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining
unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before 07/02/10. Because Section 2136 (d) of the 1995
Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would
exceed the maximum time permitted.
We now offer you the option to request your extension request via a-mail. Please use the following e-
mail address: RA-InheritanceTaxExt~state.pa.us. Please contact me with any questions or concerns at
717-787-8327.
Sincerely,
Claudia Maffei, Supervisor
Document Processing Unit
Inheritance Tax Division
Please do not reply to this email. This mailbox is not monitored and you will not receive a response. For assistance, visit us on the web
at www.revenue.state.pa.us or call us at 717-787-8327
The infomtiation transmitted is intended only for the person or entity to whom it is addressed and may contain. confidential and/or
privileged material. Any use of this information other than by the intended recipient is prohibited. If you receive this message in error,
please send a reply e-mail to the sender and delete the material from any and all computers.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 17128-0801
IECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX~11-961
NO. CD 01 1420
RABER JANE
411 REESER ROAD
CAMP HILL, PA 1701 1
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
.___ ,,,,
ESTATE INFORMATION: ssN: 049-22-5833
FILE NUMBER: 2109-0555
DECEDENT NAME: SWEIGART PAULINE M
DATE OF PAYMENT: 06/30/2009
POSTMARK DATE: 06/29/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 04/02/2009
101 ~ 537,000.00
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTY
sEAL
CHECK# 4
537,000.00
INITIALS: AJW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
~~uOHwEALTN OF PENN9YlVA-RA
OEPNRMR+T Of RlVEN{lE
BUREAU OF NrWVINVAI TAXES
06Yi.78060ti
MpgR168LIRG, PA 171seaeol PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
QFFICIAL RECEIPT
RAKER .PANE
411 REESER ROAD
CAMP HILL, PA 17011
ACM
ASSESSMENT
CONTRdL
NUMBER
,~ _r
ESTATE INFORMATION: 6SN: 449-22-5633
FILE NUMBER: ~ 2109-0555
DECEDENT NAME: $WEIGART PAULINE M
PATE OF PAYMENT: 12/31/2009
POSTMARK DATE: 12/30/2009
couNTx: CUMBERLAND
DATE OF DEATH: 04/02/2009
R6Y•11d2 EX(t1~9i
rva. c~ o~ z~ ss
AMOUNT
101 ~ 522,250.00
I
i
L~
TOTAL AMOUNT PAID:
REMARKS:
CHECK#101
522,250.00
INITIALS: SAP
s~ RECEIVEd BY: GLENDA EARNER STRASBAUGH
REQISTER pF WILLLS
REGISTER OR WILLS
LAST WILL AND TESTAMENT ~ n t ~J~
OF ~/ u
PAULINE M. SWEIGART
I, PAULINE M. SWEIGART, of the Township of Lower Allen, Cumberland
County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils by me at any time made.
ITEMI~ I direct that all inheritance and estate taxes becoming due by reason of
my death, whether such taxes may be payable by my estate or by any recipient of any
property, shall be paid by the Executor out of the property passing under ITEM III of this
Will, as an expense and cost of administration of my estate. The Executar shall have no duty
or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of
insurance or other property not passing under this Will.
LT~M.IIi I direct the Executor to pay my just debts and the expenses of my last
illness and funeral expenses from the property passing under this Will as an expense and cost
of administration of my estate.
ITEM III: All rest residue and remainder of the estate shall be paid as follows:
(a) Twenty percent (20%) to my nephew, Roderick Richard Sweigart or, in the
G'
event he predeceases me, to his issue, per stirpes;
(b) Twenty percent (20°l0) to my niece, Pamela Jo Sweigart or, in the event that
she predeceases me, to her issue, per stirpes;
(c) Twenty percent (20%) to my nephew, William Bradley Sweigart. In the event
that my nephew continues to be on social security disability at the time of my
death, I direct that said share be paid to Jeanne B. Sweigart, as Trustee of
William Bradley Sweigart and used for William Bradley Sweigart's benefit as
the Trustee, in her sole discretion, shall deem appropriate. Jeanne B. Sweigart
shall have the right to designate any subsequent Trustee;
(d) Twenty percent (20%) to my niece, Kimberly Sweigart Conley or, in the event
that she predeceases me, to her issue, per stirpes;
(e) Ten percent (10%) to Joseph Goss, son of Jeanne B. Sweigart or, in the event
he predeceases me, to his mother, Jeanne B. Sweigart;
(f) Ten percent (10°to) to my great nephew, Sean Sweigart, or, in the event he
predeceases me, to his issue, per stirpes.
2
If any of the foregoing beneficiaries die without surviving issue, or is not survived by
the beneficiary designated above, his or her share shall be divided in equal shares between
the surviving beneficiaries.
I~'~1VI IV: In the settlement of my estate, my Executor shall possess, among others,
the following powers:
(a) To retain any investments I may have at my death, as long as the Executor may
deem it advisable to my estate to do so;
(b} To sell either at private or public sale and upon such terms and conditions as
the Executor may deem advantageous to the estate, any or all real or personal property or
interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do all other acts in the Executor's judgment deemed necessary or desirable
for the proper and advantageous management, investment and distribution of the estate.
ITEM V: Any person who shall have died at the same time as I shall have, or in
a common disaster with me, or under circumstance that the order of deaths cannot be
established by proof, or within thirty (30) days of my death, shall be deemed to have
predeceased me.
I M VI: I nominate, constitute and appoint my nephew, RODERICK
RICHARD SWEIGART and my friend, JANE RABER, as Co-Executors of my estate.
In the event either of my Co-Executors are unwilling or unable to act, the remaining named
Executor shall act as sole Executor. Any Executor or Executrix is specifically relieved from
the duty or obligation of filing any bond or other security.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of this and the preceding three (3) pages, at the end of each
page of which I have also set my initials for greater security and better identification this
day of August, 2001.
- ~ ~' (SEAL)
PAULINE M. S ~ GART
4
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and Testament,
in the presence of each other, have hereunto set our hands and seals the day and year first
above written, and we certify that at the time of the execution thereof, the said Testatrix was
of sound mind and memory.
~~~a (~L'~1z-~,,~~ Residing at: 325 Third Street
Lisa Wasserloos New Cumberland, PA 17070
• / ~ ~ ' ~ Residing at: 2670 Conewago Road
aura 3. ghes- oyle Dover, PA 17315
5
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, PAULINE M. SWEIGART, Testatrix, whose name is signed to the attached or
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.
~- (SEAL)
PAULINE M. SWE ART
Sworn to and subscribed
before me this /~ day
of August, 0 .
`;
NOTARY PUBLIC
My Commission Expires: ~i~c
A~aleelon Ehplwe Norenber t6,
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
. SS.
We, Lisa Wasserloos, and Laura J. Hughes-Doyle, the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were.present and saw Testatrix, PAULINE M. SWEIGART, sign
and execute the instrument as her Last Will and Testament; that Testatrix signed willingly
and she executed said Will 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 that time eighteen (18} or more years of
age, of sound mind and wader no constraint or undue influence.
~a ~r~~~
- ,,~~~
~~ ~~[/, 1
~~1~ ~~ ~_ jt f
THE S `" ,,
:~
Sworn to and subscribed
before me this /`~ day
of August, X01,
Y PUBLIC
Mosier. soa
My Commission Expires: ~Pu~o
(SEAL) faoeMelrloRl~~Nora~r ~
ADDENDUM TO
LAST WILL AND TESTAMENT
OF
PAULINE M. SWEIGART
,OOPS
ITEM III: All rest residue and remainder of the estate shall be paid as follows:
a) Twenty percent (20) to my nephew, Roderick Richard Sweigart or, in the
event he predeceases me, to his issue, per atirpes; shall read twenty
percent (20) minus ten thousand dollars ($10,000.00) to my nephew,
Roderick Richard Sweigart, or in the evennt he predeceases me, to his
issue, per stirpes. This amount of $10,000.00 shall be divided among
the remaining beneficiaries according to percentages of original will.
~~ ~~
PAULINE M. S IGART
Sworn to and sn~ ribed
before me this day
of December, 2002.
~~~
ti~/E.
1~T ARY PUBLI
My Commission Expires:
(SEAL) ---
NOTARIAL SEAL
BARBARA STUMP, Notary Public
Camp Hill Boro, Cumberland County
My Contmiesbn Exp~r~ Nov. 12, 2006
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Exelon Corp. (EXC) At 3:38PM ET: 50.21 * o.za {o.4s"ion
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VKPAX: Historical Prices for VAN KAMPEN PENNSYLVANIA TXFR IN -Yahoo! Fi... Page I of 2
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Pionee!r.Av (PIODX) on Dec a: 34.89 +0.35 (0.99°!0)
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Start Date: Api_ :,~ 2^... .. 2009 _ Eg. ]an 1,
2003 ~' Weekly
End Date: Apr :=' J2 ~ 2009 C Monthly
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PRICES PIuS a S#t"r?c~t71
cif ir~~ame to
Date Open High Low.. Close Volume Cl~se" prptect you
2-Apr-09 26.93 26.93 26.93 26.83 0 26.77 If ~h~ ~'~r1C~'t
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VKMPX: Historical Prices for VAN KAMPEN PENNSYLVANIA TXFR IN -Yahoo. Fi... Pa e 1 of 2
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Van Kampen PA Tax-Free Income A (VKMPX) o~ Dec e:15.68 ~r o.oa io.19%1
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._._.........i ... _........._._.12003
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2-Apr-09 14.26 14.26 14.26 14.26 0 13.85
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fiurn here-
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ta.s. ~•~„~. cyan ~.
abjttirsa ss!e hcra.n, caa€:;sk
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http://finance.yahoo.corn/q/hp?s=VKMPX&a=03&b=2&c=2009&d=03&e=2&2009&¢=d 12/9/2(1(14
Jul. ll. 2009 12:13PM PNC BANK 412-705-2747 No. 6395 P. 1/1
~~
I.EA~I~ THEWAY
July 17, 2009 .
Amy M Moya, Esq.
Suess F Lederer Offieeg
5011 Locust Lane
xarrisburg, PA 17109
RE: Pauline M Sweigart
SSN:049-22-5833
DOD: 04-02-2009
Dear Ms: Moya:
In response to your roquest for Dato of Death (D4D) balances for the customer, Doted above, our
records show the following:
Checking Account
Accoutrt # 5140219525
PAUI.INE M SWEIGART
DOD balance: $23,499.26 + 1.28 accrued interest
Interestpaid O1-oi-2009 thtu o4-02-2009 $ 9.41 YlD
Savings Account
Account # 5003816331
PAULINE M SWEIaART
I~OD balance: $ 32,552.24 + 13.20 accrued interest
Interest paid 01-0i-2009 tluu 04-02-2009 $•64.25 YTD
Established: 10-0 l -1977
Established: 06-21-2001
PIease note that this office provides date of death balances for deposit accounts (IltAs, CDs, Checking and
Savings). VNe do not prncesa.any f"inamclal transactions or provide statements. Tf you need assistance with
any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
o~xce,
Sincerely,
National Financial Services Cemer
PNC Bank, N.A. ~ ~•
Ilriettaber FDIC
Page`1 of 1
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Al-slate Insurance Company ~` A 11 state m
10815 David Taylor Dr You're in ood hands.
awriotte, Nc18z62aoa6 S
Information as of April 9, 2009
{u,{{{,u{{{,nn,{{,n{{u,{{n{{r{{nn{{nm{{,,,{{{u{,{ Policyho{der Page 1 of 1
PAULINE SWEIGART Pauline Sweigart
C/0 JANE RARER [/O Jana Raber
411 REESER RD Polic number
CAMP HILL PA 17011-1306 098650913
Property
4837 E TRINDI.E RD
MECHANIt56URG PA 17050
. ~ - -..;.YourAllstate agency is
..,..Paul Mottos Agy Inc
What you should know - ~' 3s,o Market st
Camp Hill, PA 17011
....
As you requested, we have terminated your policy effective April.lQ, . - - (717) 731-5456. _ .. . , .. _-
2009. Attached is your refund check. We thank you for the
opportunity to serve you and hope we can provide your insurance
protection in the future.
if you have any questions, please contact your agent or producer of
record. .
Payment history
6/12/08 Previous balance $70.17. -
7/5/08 Payment received - $70.17 -.
4/9/09 Policy cancellation adjustment - $1b.00 ~ .
4/9/09 Refund issued $16.00::.. „
Balance ~$ 0.00
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JAN-06-2010 15 03 MORGAN STANLEY SMITH BARN
-- - ~~1QD OO Lutu aa•~~•» •aw swn - .... ,_ ____ __ _
January G, 2010
Kathleen
FAX 717-Z55-6GS l
717 255 6651 P.02
~xb..e. ~~,<,,, t.2 ~j ~ ~ 1
H~Irtfcar. c~ I,i~'i~
Re: H3rtfurd Annuity Cuntraa ~ ? 10684953 ~ ;~ ~ ,
Decedent: PAIILINE 1+1 SV1'EIGART
Dear Ms. Kathleen; •
';..
Thank you for your corre~wndettce rcgardiTtg the above annuity'cts~itraq.....
,. -
'.
The death beneftt payable under this cwttract is nat considered '`life iiis~itanc'.`•;tipbrtable on:IltS•:~ ~~.`::. ~- - .
form 712, (life insuranlx statcmetlt). I'lcase find the below information~in t~spoiuii;to'.your ~:~:~~ ""`,.'.'~•
rt:gttest.
Col~tracl Nrtmh~r 7 t 0684953 ~ . ~. .
~11'IJeI PAUL.INI: M. SWIdiGAR~~`>.-~.~ ~;~~ ~~'.
Dect!dent f'AULINE M SW~I(rART:,'~'..•:: ~.~';~:~::
S~oc;ia! Security Nainber XXX-XX-583:t .
Dale of Death Apri12. 2009
Cash Value on flee date of death 542,223. t o ~ '::. ~ . ~ .
Deutk ,Ilepeftt Value on the dale of daath* Sas,179,23 •' ~.• ..;;:.;~;:'~`.
J"
'The Oglih t3crlotit vatllc 011 the date o1' death disp[a~cd abo~r: map.3itchldE >t .~t=AQ~tisfmcril~a's:`~'
....
outlined in t.hc lulnuit~ Calltract. This r~ure is t+efng Rcwideda`oriUi'uitrittion''purposot;atti8,i~;quiv~l~nYio ttic' ~ ~ ;
tilwl d~agl beltefit. 111e deaitt bencl'i{ will bt: calCltlital~-oii~itllfioiitt~[s.asslsoiatai•w;th:alris•~ci~ent~~tki:"ikiv:wc; ~,'~;~
reces~c file certified death rxriifi~te. OIICC U~c.t3¢atfi belidit;is caul'SCcii:=ihCbei~lit:amotiiiil.rpifain6 irii°cstect'ahd• •~• ;-
is su~kxt to nmrld llu~tuation until oompkfc~#cttkmitat+nSinktioile3r~'receivad.';~. '.•..:!' -: 'i ~_
Ifyau have any questions or c:oncc~n~:~jilc~soi'eel~free to cdtitiicC~j-itiur~itivitstfTren .p~~' ~ '::fin ,.t;- ,
C~ roficssl al~:
one of our annuity s{~cciatlists by calliiig~l-Boo=BG~fiGGB„Monday tti~rou~:'1'liursday!'i~ii'm:8~:atti::~~:~'
to 7 p.m. Illld Friday Gant 9;15 a.m~•to;Glp:~.;l:astern Staodard~~Zttiis:~~We:wtll~-1inliappjito~tissist"-~
i..• .. .
you. Thank you for the ~rppaltunity:to7ielp:pt'6vida`.for;yauP'fYn'antiiil. na;~ds:`.-~::=:~ - ~~ ~`~-~:;'.~ ~;':
a'> ''~. ~' :. '' ' ~• is ~~..:•~.' i:':. '•.•.
Sincerely, r ~ :. ::,::::.-' - ;;~ ~.tta>~r. t~~;~;~fi.;~.M-~
":•:r~~ W'ai~Lr;:Cf.~Utr~s:a~s7z .. .
:. ... .. - TotlYrceJ•~8xlo8G2.GGiti>r
InraKlnws~eP-ii0u~{•SM~ioo~:
B Eaton ~.? .,..:..._...,:...,,....... ~:,: .....
(nvcstrnent Prlxluct Services :~ `" nixu~„s.:wd~ire+Y::i•;i5-ti~~~ Wss
'~~ ~••'•• :,. r}Idrtfo~d;.Cf,~DG102.5685 .
ICS Annuity Benefit Services '1.'eam "' '-~ ~~ ~ '~w;n~:r~~n+rins~.ar~°:.'
Hartford 1..it'e and Annuity Insurance patiys•. `, - `; ,
,;,;.
- •'
TOTAL P.02
SEP-25-2009 11 57 MORGAN STANLEY SMITH BARN '717 255 6651
4507 , ~'arth Cront 5trtrt
Suite 20i
Hamsburg, t'A 1 i 11 u
direct 717 255 C><6G
fax 717 255 GGS 1
roll (rce A00 G7G 0673
Susan E Lederer Law Office
5011 Locust Lane
Harrisburg, PA 17109
September 25, 2009
Dear Orella,
The beneficiaries for Pauline Sweigart's annuities are listed below:
• Allstate Annuity Contract Number 358930
Vernon Conley
Megan Conley
• Allstate Annuity Contract Number 358932
Stephen Sweigart
Aazan Sweigart
• The Hartford Contract Number 710684953
Kimberly Conley
Roderick Sweigart
Pamela Sweigart
William Bradley Sweigart
Joseph Goss
Sean Sweigart ____
If you have any questions, Please call Kathleen at (717) 255-6676.
Sincerely,
~~~.
Kathleen Bencfiel
Sr Client Service Associate
P.02
MorganStanley
SmithBarney
TOTAL P.02
Allstate Lite Insurance Company
A Ilstate ~ Topeka, KS 6b675-8565
You ie fn mod kends.
December 17, 2009
Itrtlll~~rl~r~ll~~tllll~t~ll~ttl
BARTOLI/BARTOLI/SEIGIMCCOACH
4507 N FRONT STREET SUITE 201
HARRISBURG PA 17110
5~~~~ ~~
PRODUCER COPY
Re: Contract Number: 358930, PAULINE M SWEIGART
Dear Ms. Sweigart:
Page 3
Allstate Life Insurance Company strives to maintain high quality standards and deliver exceptional
customer service each and every time you do business with us.
The date of death value on the above referenced contracts are as follows:
CONTRACT 358930 $12,257.70
CONTRACT 358932 $29,298.87
We appreciate your business and are pleased to have the opportunity to service your f nancial needs. If
you have additional questions, please call our toll-free Service Center number at 800-457-7617.Our
service representatives are available to assist you from 7:30 AM to 5:00 PM Central Time.
Sincerely,
Allstate Life Insurance Company
The variable armuity. Morgan Stanley Variable Mnu'ty 11, is isstxd by AAstate Life hnurartoe Company. This statement is proyfded on behaN o1 ALFS.
frrc„ as principal underwriter. Tha prtndpal urnierarrksris not, end fs nol rac~ired to be, a member of IM Securities Investor Protection Corporation
('SIPC•I. Amuitfes are not protected by SIPC as to the loss of principal invested,
SEP-25-2009 11 57 MORGAN STANLEY SMITH BARN 717 255 6651 P.02
4507 North Front Su~ct
Suirr 20l
Harrisburg, i'A 17110
direst 717 Z5.5 C>(6Ci
fax 717 255 GG5 t
toll free 800 C,7G O(i73
Susan E Lederer Law Office
5011 Locust Lane
Harrisburg, PA 17109
September 25, 2009
Dear Orella,
The benefciaries for Pauline Sweigart's annuities are listed below:
• Allstate Annuity Contract Number 358930
Vernon Conley
Megan Conley
• Allstate Annuity Contract Number 358932
Stephen Sweigart
Aazon Sweigart
• The Hartford Contract Number 710684953
Kimberly Conley
Roderick Sweigart
Pamela Sweigart
William Bradley Sweigart
Joseph Goss
Sean Sweigart
If you have any questions, Please call Kathleen at (717) 255-667b.
Sincerely,
Kathleen Benefiel
Sr Client Service Associate
MorganStantey
SmithBarney
TOTAL P.02
~~~~c ~~ ER~'`~N AVER CRE~VIATIUN SERVICES OF PENNSYLVANIA INS.
4Ap ~.~' -t1Uu Jonestna•n Road • tiarrisbur„ P:1 1 i 1i~9 • 1-5U0-?2U-S2' 1 • l~ae %1?-i31-~)9-~ i • Shau'u li. l;.trper, Sap~r~risor
.. „•:j
r\+
Apr 3 , Z009'' i ~ ~ ~: } •
_,. ,.. •
' •• - '•290378 MC5
..:~. .
.... c:. ~, ~' .
~ ~ 1:
~ --
Mrs . Jane Raber ~- - ••
411 Reeser Road - - - ~ •~•~•` • -
Camp Hill, PA 17011 - ~-}•~-•~ - = -
.. ~. .. .~
Pauline M. Sweigart ~ •DeceaSeid= ' ' -
.. ., .,.
SPECIAL CHARGES = '~'- '
X Direct Cremation "~_ ~ $1,395°.00-'
X Na`tiontiride Guarante~~Programr~• ~i•~ ~ - •• i • =' $295•:00
Worldw~.de Trave`1•' Protection " ' . ~ ` , .: • . - •
TOTAL SPECIAL CHARGES 51,690.@@
PROFESSIONAL SERVICES •
- R Services of Funeral Director & Stat•f• ••~• ••• - •'"~'-lnCluded
Other Preparation of the Body
Faci 1 hies & Stmt for Memorial Service ~ ' ~' ~ ~-;'~ ~'~
Staff & Equipment tor~~Meimoriai Service •~ -= - • • -
W i mess i ng the Cremat•i on •'~ • •• •~~ - - ~ - - -
Private Family Viewing/Witnessing Cremation` `-•- •
Packaging And Forwarding Cremated Remains ~~~- ' • ' • • - -•
Personal Delivery of Cremated Remains ~~ •'
Scattering of Cremated Remains •
Medical Documents/Courier Fee ~ "'~
... w t
TOTAL PROFESSIONAL SERVICES - -~ '•= $@.00
AUTOMOTIVE EQUIPMENT • • • - • ~ • • `-' •• ~ ~~ •• '~"
Removal Vehicle •
bead Car/Clergy Car
Family Car
Service Verricle• • - ••
TOTAL AUTOMOTIVE EQUIPMENT
$0.0@
MERCHANDISE
Register Book
Memorial Cards
Thank You Cards
Remembrance Package
X Cremation Cantainar
Cardboard Contain®r
Urn Burial Vault
Veterans Flag Case
Grave/Memorial Marked
TOTAL MERCHANDISE
$0.00
CASH ADVANCED ITEMS -
,.. s.
Grave Opening _.
Cemetery Equipment ~ ~• _
X Harrisburg Patriot -Actual Cost $265.b2
X Newspaper
Vaui t Service Charge., ~, _ ., •
Clergy
Church/Organist/Soloist
Flowers ~. .
Crematory Charge ,.;, .. ~.
X County Coroner Cremation Approval.,Fee _ $25•.00--
X 20 Certified Copies of Death„Certificate ,~ •~ $120, 0Q
_ ~.... .
TOTAL CASH ,ADVANCED ITEMS - ~ . ~ _ _ ' $ 410.6 2 ~~'~~~~
SUMMARY OF CHARGES .... ~..: .
Special Charges , _ _ $i,b90.00 _ _ .
Professional Services $0.00 _ _ •
Automotive Equipment;, $0.00 _ ,_ _ „ : ~ . _
Merchandise . ~ _. -- -- . $0.00 • ~,;,r,,. . _ ~ ..
Cash Advanced Items.,_ .. $41.0.62 , _ --_~ . ,- ,_ _
SUB TOTAL $2 ,1.00 ..62 ~ ~ :... - +.. _ ..,
AMOUNT PREPAID Date Feb 20, 1995 -$840.0 ~ _ _._,~ .
TOTAL $4
AMOUNT PR2D Date Apr 6, 2009 -$410.62
BALANCE DUE $ 0.00 .. , •. ~ ~ .
THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES
9
i
January 26, 2010 ~o ~:~
~,-;,
r.:°°~~ ~
j~L7 ~ -
Register of Wills ~ , ~ ~ -
Cumberland County Courthouse `-~ ~ = `:
1 Courthouse Square ~' ~. - '~ ~_ _~~
Carlisle, Pennsylvania 17013 ~
RE: ESTATE OF PAULINE M. SWEIGART
SOCIAL SECURITY NO.: 049-22-5833
DATE OF DEATH: 04-02-2009
FILE NO.: 2009-0555
Ladies and Gentlemen:
Enclosed for filing with your office please find two (2) completed Form REV-1500 with the
following attachments:
Date of death valuations;
Copy of the Last Will of Pauline M. Sweigart;
Copy of an Addendum to the Last Will of Pauline M. Sweigart; and,
Check made payable to "Register of Wills, Agent" in the amount of $294.07
for additional Inheritance Tax due.
Also enclosed for filing with your office is one (1) original Inventory for the above-
referenced Estate, and one (1) check made payable to Register of Wills in the amount of $80.00 for
additional probate costs and filing fees. Please advise if any additional fees or expenses are due with
regard to this matter.
One (1) additional photocopy of the front-page of the completed RF,V-1500 form and one (1)
additional photocopy of the front-page of the completed Inventory for the Estate have been provided.
Please time/date stamp these copies as received and return them to me in the envelope provided.
If there are any questions or further requirements regarding this return, please do not hesitate
to contact me.
incerely
A y M. Moya
Enclosures
5011 Locust Lane • Harrisburg, PA 17109 • Phone 717.652.7323 Fax 717.652.7340 • susan@ledererlaw.com
www.ledererlaw.com