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03-0699
PETITION FOR PROBATE and GRANT OF LETTERS c2. also known as To: Register of Wills for the ~ Deceased. County of C'_~,/_,~,~A~57' in the Social Security No. /~'/- _~/' (~'~ ~/,~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an thq execut0 ~'~ named in the last will of the above decedent, dated o3c.-P~. ! 0 j / 9 ~0 , 19__ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in COo ~t-~ ~) O..fx ] 0 r~v_J , coAun.ty, Pennsylvania, with h o,L r- _ last fami~ or principal, residence at ~'~.5' (list street, number and muncipality) Decendent, then (-~ ~' years of age, died at Carlisle Regional Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: ~O, OOo. o O (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: /~V~ ago~ c~ WHEREFORE, petitioner(s) respectfully request(s)~ the prob~ate of the last will and codicil(s) presented herewith and the grant of letters '7'-e ;Y~'9 ~ ~'~ 7'~,~ q (testamentary; administranon c.t.a.; administration d.b.n.c.t.a.) theron. , : ,/,/ - .- ..... OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLYANIA The petitioner(s) above-named swear(s) or 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. to or affirmed and subscribed ~ ~~ ~ ~ e me this ~ 22nd day of [ ~/. In the Court of Common Pleas of Cumberland County, Pennsylvania IN RE: ORPHANS' COURT DIVISION Estate of Arlene J. Swartz NO. 2003-00699 Status Report Under Rule 6.12 Name of Decedent: Arlene J. Swartz Date of Death: 811112003 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date:~[/)-~//~" ..nr u / - - Nam~j/ John DeLorenzo~ Esq Address: 320 Market St ~.' Harrisburg, PA 17101 Telephone: 7171234-4161 Capacity: Personal Representative X Counsel for Personal Representative NO. ~2003-699 Estate Of ARr,~qE J. SWA~Z ,, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Auqust 25th :¢~_2D_Q~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October, 10th, 1980 described therein be admitted to probate and filed of record as the last will of ARr~,~IE J ~ SWARTZ ; and Letters TE~qTAM~;~x~T AIrY are herebY granted to JEFFREY r.~.~. SWARTZ AND RONALD K. SWARTZ FEES Probate, Letters, Etc .......... $. 235.00 Short Certificates(l~ .......... $ B6.00 ^ITORNEY (Suv. Ct. I.D. No.) Pa~~_x · · x~.P. age~ · (. 2 ) $ 6.00 JCP $ 10.00 ADDRESS TOTAL __ $ 287.00 Filed .August. 25.th,. 2D.03 .............. PHONE Call Tracey if letters are finished early - 249-1951 If not ready before 3 call Jeff Swartx at 243-8390 :% 105.805 REX,.' 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 t(; the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ,,,,,~ ~ Local Registrar P 609225 AUG 13 2003 No. ~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Arlene J. Swartz _ 6343 ,.Aug. 11, 2003 68 ~. : : 15,1935 Carlisle,PA Cumberland Carlisle Regional Medical Center ~~.~ ~ite ~od corporation ~ ~ ~.~ 235 Mt. Zion Road Carlisle, PA 17013 -~ ' "~'~m'~ Cumberland Orden Husler Edna Dyarman Tracy Swartz ~ c,~O ~ 16, 2003 Westminster Memorial Garden. Carlisle, PA 17013 ffm n- Fu r me ~.~.~. 219 N. Hanover ~., ~ar}~e, P~ ~0~ .... , ~ - ~ .......................................................................................... 0 Carlisle 21-2003-699 LAST WILL AND TESTAMENT ARLENE J. SWARTZ I, ARLENE J. SWARTZ, of Lower Frankford Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, revoking all other wills and codicils heretofore made by me. FIRST I direct the payment of my debts and expenses of my l~ast illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate, in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, in this connection, I authorize my personal repreSentative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath my entire estate, of whatever nature and wherever situate, together with all insurance policies thereon, unto such of my children as survive me by thirty (30) days, per stirpes. LAW OFFICES FISHMAN & HESS CARl. ISLE, PENNSYLVANIA 17013 II THIRD In addition to the powers conferred by law, I authorize my Executor(s), in his absolute discretion: 1. To retain in the form received, and to sell either at public or private sale any real or personal property. 2. To manage real estate. 3. To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of dive rsi fication. 4. To exercise any option or rights arising from ownership of investments. 5. To compromise claims without court approval, and without the consent of any beneficiary. FOURTH I nominate, constitute and appoint my sons, Jeffrey Lee Swartz and Ronald K. Swartz, Co-executors of this my Last Will and Testament. I direct that my said Co-executors shall not be required to post bond or other security which may be required by the Commonwealth of Pennsylvania or otherwise. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of two (2) pages, the first of which bears mysignature in the margin for the purpose of identification, this the [O~ day of Oc/~cb~. , 1980. Signed, sealed, published and declared by the above named testatrix, ARLENE J. SWARTZ, as and for her Last Will and Testament, in the 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. FISHMAN & HESS CAI~I.,ISLE, COMMONWEALTH OF PENNSYLVANIA: :SS. COUNTY OF CUMBERLAND : Arlene J. Swartz, Robert L. O'Brien and Kevin A. Hess, the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the under- signed authority that the testatrix signed and executed the instrument as her last will, and that she signed willingly, and that.she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witnesses, and that to the best of their knowledge, the testatrix was at the time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Sworn to and subscribed before me this 10th day of October, 1980 BiY {:OMN';:SSidN ~XP',RRS D~C. 31, ~%3 Member Pennsylvania Association o~ Notaries LAST WILL AND TESTAMENT OF ARLENE J. SWARTZ LAW OFFICES FISHMAN & HESS 128 SOUTH HANOVER STREET CARLISLE. PENNSYLVANIA 17013 ~ ,~L COHMONHEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 171Z8-060! APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-I;q7 EX DATE 08-09-ZOOq ESTATE OF SHARTZ ARLENE J DATE OF DEATH 08-11-2005 FILE NUHBER 21 05-0699 COUNTY CUMBERLAND JOHN DELORENZO ESQ ACN 101 GOLDBERG ETAL f Amount Remitted PO BOX 1268 HBG PA 17108 HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS REV-154? EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOHANCE OR DZSALLOHANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX ESTATE OF SHARTZ ARLENE J FILE NO. Z1 03-0699 ACN 101 DATE 08-09-ZOOq TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURII 1. Real Estate (Schedule A) (1) 118z9~0.00 NOTE: To insure proper 2. Stocks end Bonds (Schedule B) (2) ~,187.81_ credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) ($) .00 submit the upper portion q. Mortgages/Notes Receivable (Schedule D) (q) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 19/115.~ tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 7q;50~.33 (S) 216,7~7.58 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 18,80~.05 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (91 10 Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 10,09~.00 · (11) 28.898.05 187,8q9.53 11. Total Deductions (12) 1~. Net Value of Tax Return O0 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) ' 187,8~9.53 NOTE: I~ an assessment ~as ~ssued prev~ousZy, l~nes l~, 15 and/, reflect figures that include the total of ALL returns assessed to, ate ASSESSNENT OF TAX: .~.X 00 %':~:i. .00 15. Aeount of Line lq at Spousal rate (1S) ~ 16. Amount of Line lq taxable at Lineal/Class A rate (16) 187,819. X 0t5~ ..... Bj~53.Z3 x lz .oo 17. Amount of Line Xq et Sibling rate (17) o~x 15 -a~ . O0 18, Amount of Line lq taxable at Collateral/Class B rate (18) ' (19,~-. 19. Principal Tax Due TAX CREDITS: PAYMENT / R~CEIYI DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-} 06-Oq-ZOOq CD00~019 .00 8,~BZ.Z3 TOTAL TAX CREDIT I 8,~5Z.23 [NTEREST IS CHARGED THROUGH 08-2~-ZOOq ~ALANCE OF TAX DUE/ 1.00 AT THE RATES APPLICABLE AS OUTLINED ON THE INTEREST AND PEN. / 22.33 REVERSE SIDE OF THIS FORM TOTAL DUE ~ 23.33 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decadents dying on or before December IZ, 19BI -- if any futura interest in the estate is transferred in possession or enjoyment to CZass B (coJlateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CommonmeaIth hereby axprmssZy reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rate on any such futura interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Z14O of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of #i118 printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT REFUND (CR): A refund of a tax credit, Nhich Nas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z~-hour ensnaring service for forms ordering: 1-aoo-36Z-Z050; services for taxpayers Nith special hearing and / or speaking needs: 1-800-6~7-30Z0 (TT only). OBJECTIONS: Any party in interest not satisfied aith the appraisement, alloNance, or disalloNancm of deductions, or assessment of tax (including discount or interest) as shoNn on this Notice must object NJthin sixty (60) days of receipt of this Notice by: --written protest to the 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 the personal representative, OR --appeal to the Orphans' Court. ADHIN- ISTRATZVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in Nriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment RevieN Unit, Dept. 280601, Harrisburg, PA 17128-060I Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-lEO1) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid NJthin three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you Nould appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning NJth first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes Nhich became delinquent before January l, 198Z bear interest at the rate of six (aZ) percent per annum calculated at a daily rate of .000166. All taxes Nhich 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 the PA Department of Revenue. The applicable interest rates for 198Z through 2006 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOX .0005~8 ~)'~"~ - 1991 11Z .000~01 ~ 9Z .0002~7 1983 X6Z .000638 1992 9Z . OOOZ~7 2002 6Z .00016~ 198~ 11~ .000301 1993-199~ 7~ .000192 ZO0~ 5~ .000137 1985 X3Z .000356 1995-1998 9Z .0002~7 ZOOq ~Z .000110 1986 10Z .000Z7~ 1999 7Z .00019Z 1987 10Z .000Z7~ ZOO0 7Z .00019Z --Interest is calculated as ~ollows: ~NTBRES~ = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DA~LY INTEREST FACTOR --Any Notice issued a~tec the tax becomes delinquent ~]11 collect an interest calculation to fifteen (15) days beyond the date o~ the assessment, l~ payment is made a~tec the interest computation date sho~n on the Notice, additional interest must be calculated. IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS ARLENE J. SWARTZ, : CUMBERLAND COUNTY, PENNSYLVANIA Deceased : ORPHANS' COURT DIVISION : No. 2003-00699 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Arlene J. Swartz, deceased Date of Death: August 11, 2003 Will No. Admin. No. 2003-00699 To the Register: I certify that notice of estate administration 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 September 12, 2003: Jeffrey L. Swartz 169 Limekiln Road, Carlisle, PA 17013 Ronaid K. Swartz 1189 Easy Road, Carlisle, PA 17013 Tim L. Swartz 334 Old Mill Road, Carlisle, PA 17013 Tracy L. Swartz 235 Mt. Zion Road, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto~~6(a)except _N/A. Date 7/t2./o3 ' Signature Name //Jf~oh/n DeLor n~zo, Esquire Address VGoldberg, Katzman & Shipman, P.C. P.O. Box 1268 Harrisburg, PA 17108-1268 Telephone (717) 234-4161 Capacity: __ Personal Representative X Counsel for personal representative 320 MARKET STREET · STRAWBERRY SQUARE P.O. BOX 1268 · HARRISBURG, PENNSYLVANIA 17108-1268 717.234.4161 * 717.234.6808 (FAx) GOLDBERG, KATZMAN ~ SHIPMAN, P.C. ATTORNEYS AT LAW August 10, 2004 Register of Wills Cumberland County Courthouse OF COUNSEL 1 Courthouse Square nEE S.IPMAN Carlisle PA 17013-3387 Re: Estate of Arlene J. Swartz COUNSEL JOSHUA D. LOCK NO, 21-03-0699 ARNOLD B. KOGAN Madam: ARTHUR L. GOLDBERG (19Sl-2OOO) Enclosed please find our check in the amount of $23.33 as additional HARRY B. GOLDBERG inheritance tax due. (1961-1998) RONALD M. KATZMAN PAUL J. ESPOSlTO NElL HENDERSHOT Very truly yours, THOMAS E. BRENNER JOHN A. STATLER APRIL L. STRANG-KUTAY Mark B. Hammond GUY H. BROOKS Paralegal JEFFERSON J. SHIPMAN Encl. JERRY J. Russo ~:'t MICHAEL J. CROCENZI 110421.3 THOMAS J. WEBER STEVEN E. GRUBB JOHN DELORENZO JOHN R. NINOSKY ROYCE L. MORRIS DAVID M. STECKEL HEATHER L. PATERNO BENJAMIN D. ANDREOZZI 320 MARKET STREET · STRAWBERRY SQUARE P.O. Box 1268 · HARRISBURG, PENNSYLVANIA 17108-1268 GOLDBERG, KATZMAN & SHIPMAN, ATTORNEYS AT LAW Register of Wills Cumberland Coumy Coua~9~ 1 Cou~house Square Carlisle PA 17013-3387 COHNONNEALTH OF PENNSYLVANZA BUREAU OF ZND/VZDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX D[V/SZON DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOT/CE OF /NHERZTANCE TAX APPRAISENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-i~7 EX ~FP (Of-OS) DATE 08-09-2004 R~ESTATEOF ::~f SWARTZ ARLENE J F~TE? OF ~H 08-11-Z005 ~ZLE NUNBER 21 03-0699 JOHN DELORENZO ESQ COUNTY CUNBERLAND GOLDBERG ETAL '0~AC~ 13 P2:27101 PO BOX 1268 I Amoun{ Remi~ed HBG PA 17108 f~!~i~I< : :~:~}L! GHm~E~}(~I~, ~j~i~ABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUN~ERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS L/NE ~ RETAZN LOWER PORT/ON FOR YOUR RECORDS REV-15~7 EX AFP (01-03) NOT/CE OF ZNHERZTANCE TAX APPR~TS;HENT, ALkOWANCE OR D~SALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF SWARTZ ARLENE J FZLE NO. 21 0~-0699 ACN 101 DATE 08-09-2004 TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSK APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Rea/ Es~a~e (Schedule A) (1) 118/940.00 NOTE: To insure proper 2. S*ocks and Bonds (Schedule B) (2) 4/187.81 credi* ~o your account, 3. Closely Held S~ock/Par~nershlp /n,eras* (Schedule C) (3) .00 submA~ ~he upper por~1on ~. Not,gages/No,es Receivable (Schedule D) (~) .00 of ~hAs form ~i*h your S. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) ($). 1~;115.44 ~ax payment. 6. Jointly O~ned Proper~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 8. To,al Asse~s (8) 216,747.58 APPROVED DEDUCTZONS AND EXENPTZONS: 18,804.05 9. Funeral Expenses/Adm. Cos~s/Nlsc. Expenses (Schedule H) (9) 10. Deb~s/Hor~gage Liabilities/Liens (Schedule /) (10) 10~094.00 11. Total Deductions (11) 28.898.05 12. Net Value of Tax Re*urn (12) 187,849.53 13. Charitable/governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) .00 lq. Ne~ Value of Es~a~e Sub~ec~ ~o Tax (lq) ~87,8q9.5~ NOTF~ ~ an assessment was issued previously, lines 14, 15 and/or 16. 17. 18 and 19 reflect figures that include the tote1 of ALL returns assessed'to date. ASSESSNENT OF TAX: 15. Amoun~ of L/ne Zq a* Spousal ra~e (15) .00 X O0 = .00 16. Amoun~ of L/ne 1~ ~axable a~ L{neal/Class A ra~e (16) 187,849.55 X 045 = 8,453.23 17. Aaoun~ of L/ne 1~ a* Sibling ra~e (17) .00 X 1~ = .00 18. Amoun~ of L/ne 1~ *exable e* Collateral/Class B ra~e (1G). .00 X 15 = .00 19. Principal Tax Due TAX CREDZTS: (1;)= 8,455.25 PAYHENT RECEZPT DZSCOUNT BATE NUNBER /NTEREST/PEN PAZD (-) ANOUNT PA/D 06-04-2004 CD004019 .00 8,452.25 INTEREST IS CHARGED THROUGH 08-24-2004 TOTAL TAX CREDTT ! 8,452.25 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1.00 REVERSE SIDE OF THIS FORH ZNTEREST AND PEN. I 2Z.~$ TOTAL DUE J 2~. $$ ~ /F PAZD AFTER DATE /NDTCATED, SEE REVERSE ( TF TOTAL DUE /S LESS THAN $1, NO PAYNENT /S REqU/RED. FOR CALCULAT/ON OF ADD/T/ONAL /NTEREST. /F TOTAL DUE /S REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THZS FORH FOR /NSTRUCT/ONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 19aZ -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Commonweal'Ih he~eb~ expressly reserved ti.= right to appraise and assess trcnsfer Inharitan~e Taxes at the lawful Class B (collateral) rate on any such futura interest. PURPOSE OF NOTICE: To fulfil1 the requirements of Section ZI40 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF RILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills) any of the 23 Revenue District Offices, or by calling the special Z4-hour ansmering service for fores ordering: I-BOO-56Z-Z050; services for taxpayers with special hearing and / or speak[ng needs: 1-BOO-447-50ZO (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object mithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZB1021, Harrisburg, PA 171ZB-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-iS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax duo is paid within three (3) calendar months after the decedant's death, a five per(ant (SZ) discount of the tax paid is allowed. PENALTY: The iSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (l) day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 19BZ bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 19BI will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .O00S4B ~'8-1991 11Z .000501 ~ 9Z .000247 1983 16Z .000438 1992 9Z .000247 2002 62 .000164 1984 Ill .000301 1995-1994 7Z .O0019Z 2003 5Z .000137 1985 132 .000356 1995-1998 9Z .000247 2004 4Z .000110 1986 XOZ .000274 1999 7Z .00019Z 1987 Z0Z .000Z74 ZOO0 7Z .O00ZgZ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued 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. 320 MARKET STREET · STRAWBERRY SQUARE P.O. Box 1268 · H~RRISBURG, PENNSYLVANIA 17108-1268 717.234.4161 · 717.234.6808 (FAx) GOLDBERG, KATZMAN ~ SHIPMAN, P.C.f~g} ATTORNEYS AT LAW June 2, 2004 Register of Wills Cumberland County Courthouse OF COUNSEL 1 Courthouse Square E LEE S.rPMAN Carlisle PA 17013-3387 Re: Estate of Arlene J. Swartz COUNSEL JOS.UA D. LOCK NO. 21-03-0699 ARNOLD B. KOGAN Madam: ARTHUR L. GOLDBERG (1951-2000) HARRY B. GOLDBERG Enclosed please find three copies of the Pennsylvania Inheritance Tax (1961-1998) Return and two copies of the Inventory in the above-referenced estate, together with a check in the amount of $8,453.23payable to Register of Wills, Agent as RON^LD M. KAtZ~AN payment for Inheritance Taxes. PAUL J. ESPOSlTO NEIL HENDERSHOT Please file the return and Inventory and send us copies for our files. J. JAY COOPER THOMAS E. BRENNER JOHN A. STATLER Very trgly yours~ APRIL C. STRANG-KUTAY GuY H. BROOKS / JEFFERSON J. SHrPM^N JERRY J. Russo Mark B. Hammond MIGHAEL J. CROGENZI Paralegal THOMAS J. WEBER STEVEN E. GRUBB Encl. JOHN DELORENZO 110421.1 JOHN R. NINOSKY ROYCE L. MORRIS DAVID M. STECKEL HEATHER L. PATERNO BENJAMIN D. ANDREOZZI Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Arlene J. Swartz No. 2003-00699 also known as Date of Death August 11,2003 , Deceased Social Security No. 194-26-6343 Personal Representative(s) of the above Estate, deceased, vedfythat 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We vedfy that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Personal Representative: AttorneY:i.D. ,o.: John DeLorenzo, Esquire 72190 Je]r~e, Lji~ ~'w-,a~lz, c-,,~-r.~.~.-ut~ / / //~/ ~'~l~-~e,~J~,~ ~ Ronald K. S. rtz, Co-/~ecl~(Jr' '/--- :') Address: Goldber,q, Katzmen & Shipman, P.C., 320 Market Street, P.O. Box 1268, Hardsbur,q, PA 17108-1268 Dated / Telephone: 717-234-4161 Description Value 1. Real estate located at 235 Mt. Zion Road, Lower Frankford Township, Cumberland- $118,940.00 County, PA - valued per county tax assessment 2. 4,187.81 shares Dreyfus Liquid Assets, Inc. held in Account No. 0039-0001911080 4,187.81 - valued per letter dated 10/22/03 ($1.00) 3. 2001 Pontiac Grand Am SE Sedan - valued per Kelley Blue Book 6,755.00 4. Dreyfus Liquid Assets, Inc. Account No. 0039-0001911080, accrued interest - 0.62 valued per letter dated 10/22/03 5. M&T Bank Checking Account No. 2677038727 - valued per bank letter dated 11/4/03 10,873.02 6. M&T Bank Savings Account No. 15004200944343 - valued per bank letter dated 11/4/03 441.72 7. M&T Bank Savings Account No. 15004200944343, accrued interest - valued per bank 0.08 letter dtd 1114103 8. Personal property- valued per beneficiaries ~ 1.0~5.00 I -...j Total: $ 142,243.25 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. 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 004019 SWARTZ JEFFREY LEE 169 LIMEKILN ROAD CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $8,452.23 ESTATE INFORMATION: SSN: 194-26-6343 FILE NUMBER: 2103-0699 DECEDENT NAME: SWARTZ ARLENE J ;)ATE OF PAYMENT: 06/07/2004 POSTMARK DATE: 06/04/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/1 1/2003 TOTAL AMOUNT PAID: $8,452.23 REMARKS: CHECK# 1009 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Firsx ~,la.. ~ ,v,c,,, ty Courthouse ire ,3387 :: ~' .; ~ : OFFICIAL USE ONLY R V- 5oo REV-1500 COMMO.WE^LTHOFPE..S.LVA.,^ INHERITANCE TAX RETURN ; LENUMaER DEPARTMENT OF REVENUE DEPT. 260 0, RESIDENT DECEDENT 21- 03- 0699 HARRISBURG, PA 171:~8-0601 COUNTY CODE YEAR NUMBER D I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER E I Swartz Arlene J. 194-26-6343 Ec THIS RETURN MUST BE FILED IN DUPUCATEWITH THE DATE OF DEATH (MM-DD-YEAR) I DATE OF 81RTH (MM-DD-YEAR) D 08/11/2003 01/15/1935 REGISTER OF WILLS N~ (IF APPLICABLE) SURV V NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER T 1. Original Return 2. Supplemental Return 3. Remainder Return prior xo 1~- 13-~) C A P R 4, Limited Estate 48. Future Interest Compromise (date of death after 12-12-8Z) 5. Federal Estate Tax Return Required HpRL E P I O 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8, Total Number of Safe Deposit Boxes R A C (Attach copy of Will) (Attach copy of Trust) oTK ES I-~ 9. LitlgatlonProceedsRecefved J----Il0. SpousalPovertyCredlt ~ 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch O) C O~ I NAME COMPLETE MAILING ADDRESS O I John DeLorenzo, Esquire 320 Market Street R D~ FIRM NAME (If ApplIcable) P.O. Box 1268 R~ EN ColdberE, Katzman & Shipman, P.C. Harrisbur§, PA 17108-1268 S T TELEPHONE NUMBER 717/234-4~.§~. 1. Real Estate (Schedule A) (1) 118,940.00 OFFICIAL USEONLY 2. Stocks and Bonds (Schedule B) (2) 4,1817~ ;. ~1 c~ " 3. Closely Held Corporation, Partnership or (3) i-None -~. Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None [;~: R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 19,115.44 E ~ C (Schedule E) ~ A 6. Jointly Owned Property (Schedule F) (6) None p >~ I ~ Separate Billing Requested :- ~ T U 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 74,504,33 ;~,-'~ L (Schedule G or L) :'::' A T 8. Total Gross Assets (total Lines 1-7) (8) 216 , 7/*7. 58 O 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 18,804.05 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 10,094. O0 11. Total Deductions (total Lines 9 & 10) (11) 28 ~ 898.05 12. Net Value of Estate (Line 8 minus Line 11) (12) 187,8/*9.53 13. Charitable and Governmental 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) 187,849.53 C O SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M T ~ 15. Amount of Line 14 taxable at the spousal tax A X AT rate, or transfers under Sec. 9116(aX1.2) X .0 0 (15) 0.00 T 16. Amount of Line 14 taxable at lineal rate 187,8A9.53 X .0 45 (16) 8,453.23 OI 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 N 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due (19) 8,453.23 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 235 Mt. Zion Road CITY STATE I ZIP Carlisle PA J 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 8,453.23 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments C. Discount Total Credits(A+B+C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8,4,53.23 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 8,453.23 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 ;: retain the use or income of the property transferred; ......................... 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? ................................ ~ r--1 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 per, a;tles of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIGNATUF~ PERSQJq RES~NSIB~E FOF~-~H~URN Jeff re-- Lee and Ronald K Swartz DATE ~;%" 169 L ~ ' ~/ -(7 ~~/'~'~~ ..... imeki].n Road ,,~ SIGNATURI~OFPRE' R HERTHA~J PRESENTATIVE ( '' "" ~'~ "~I~..~T ~ Goidberg, Katzman & Shipman, P.C. DAI'E ,,/ "' ~,~ f 320 Market Street, P.0 Box 1268 ..// 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,~pouse 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 ot 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(aXl )]. 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(aX1.3)]. 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. Copyright (c) :~000 form software only The Lackner Group, inc. Form REV- 1500 EX (Rev. 6-00) RE'/-15OZ EX + (1-97) SCHEDULE A COMMONWEALTH OF PEN NSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Arlene J. Swartz SS~/ 194-26-6343 08/11/2003 21-03-0699 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledc, e of the relevant facts. Real property which is jointly-owned with ric~ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Residence located at 235 Mt. Zion Road, Lower Frankford Township 118,940.00 Cumberland County, PA - valued per county tax assessment TOTAL (Also enter on line 1, Recapitulation) $ 118,9/+0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV- 1502 EX (Rev. 1-97) REV-1503 EX + (1-97) SCHEDULE B COMMO.WEALTH OF .E..SYLVA.~A STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Arlene J. Swartz SS# 194-26-6343 08/11/2003 21-03-0699 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 4,187.81 shs Dreyfus Liquid Assets, Inc. held in Acct 1.00 4,187.81 No. 0039-0001911080 - valued per letter dated 10/22/03 (attached to death tax return only) TOTAL (Also enter on line 2, Recapitulation) 4,187.81 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1503 EX {Rev. 1-97) REV- 1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Arlene J. Swartz SS~/ 194-26-6343 08/11/2003 21-03-0699 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2001 Pontiac Grand Am SE Sedan - valued per Kelley Blue Book 6,755.00 2 Dreyfus Liquid Assets, Inc. Account No. 0039-0001911080, accrued 0.62 interest - valued per letter dated 10/22/03 (attached to death tax return only) 3 M&T Bank Checking Account No. 2677038727 valued per bank lette= 10,873.02 dated 11/4/03 (attached to death tax return only) 4 M&T Bank Savings Account No. 15004200944343- valued per bank ltr 441.72 dated 11/4/03 (attached to death tax return only) 5 M&T Bank Savings Account No. 15004200944343, accrued interest - 0.08 valued per bank letter dated 11/4/03 (attached to death tax return only) 6 Miscellaneous personal property - valued per beneficiaries 1,045.00 TOTAL (Also enter on line 5, Recapitulation) $ 19,115.44 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1508 EX (Rev. 1-97) R~-~S~O EX.0-971 SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPER'I'~ RESIDENT DECEDENT ESTATE OF FILE NUMBER Arlene J. Swartz SSf; 194-26-6343 08/11/2003 21-03-0699 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THENAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (I F APPLICABLE) 1 Ahold USA 401(k) Savings Plan 40,796.84 100.00~ 40,796.84 Account No. ENV~/MG009457 MG 35845T, payable to children - valued per Account Report (att to death tax return only) 2 Western-Southern Life Assurance 27,000.00 100.00Z 27,000.00 Company Single Premium Dfrrd Annuity No. W20603576, payable to children - valued per statement dated 11/1/02 (att to death tax return only) 3 Western-Southern Life Assurance 1,161.00 100.00Z 1,161.00 Company Single Premium Dfrrd Annuity No, W20603576, accrued interest, payable to children - valued per statement dated 11/1/02 (attached to death tax rerun only) 4 M&T Bank IRA No. 35004200215041 5,545.36 100.00% 5,545.36 payable to children - valued per bank letter dated 11/4/03 (attached to death tax return only ) 5 M&T Bank IRA No. 35004200215041 1.13 100.00Z 1.13 accrued interest, payable to children - valued per bank letter dated 11/4/03 (attached to death tax return only) TOTAL (Also enter on line 7, Recapitulation) $ 74,504.33 (If more space is needed, insert additional sheets of the same raze) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1510 EX (Rev. 1-97) R~-~S~I EX +0-97) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Arlene J. Swartz SS~/ 194-26-6343 08/11/2003 21-03-0699 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 I~offman-Roth Funeral Home funeral services 5,992.50 2 Westminster Cemetery - interment services 405.00 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. Attorney's Fees Goldberg, Katzman & Shipman, P.C. 8,200.00 3. Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Tracy L. Swartz Street Address 235 Mt. Zion Road C~y Carlisle State PA Zip 17013 Relationship of Claimant to Decedent Daughter 4. Probate Fees Register of Wills 287.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Patriot News - estate notice advertisement fee 123.55 2 Cumberland Law Journal - estate notice advertisement fee 75.00 3 Vital Records - death certificates 21.00 4 Coldberg, Katzman & Shipman, P.C. - reserve for estate 200.00 administration closing TOTAL (Also enter on line 9, Recapitulation) $ 18,804.0.5 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-151:) EX + (1-97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, '""ERITANCETAXRETURNREsiDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Arlene J. Swartz SS# 194-26-6343 08/11/2003 21-03-0699 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 GMAC - loan on 2001 Pontiac Grand Am - value per telephone call 10,094.00 with GMAC TOTAL (Also enter on line 10, Recapitulation) $ 10,094.00 (If more space is needed, insert additional sheets of the same size) REV- 1513 EX + (9-oo) SCHEDULE J CO..O.WEA,T, OF PE..S¥,VA.~A BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Arlene J. Swartz SS~/ 194-26-6343 08/11/2003 21-03-0699 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a){1.Z)] 1 Jeffrey Lee Swartz Son 1/4 of Estate 169 Limekiln Road 401(k) & IRAs Carlisle, PA 17013 2 Ronald K. Swartz Son 1/4 of Estate 1189 Easy Road 401(k) & IRAs Carlisle, PA 17013 3 Tim L. Swartz Son 1/4 of Estate 334 Old Mill Road 401(k) & IRAs Carlisle, PA 17013 4 Tracy L. Swartz Daughter 1/4 of Estate 235 Mt. Zion Road 401(k) & IRAs Carlisle, PA 17013 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: Ao SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) ZOO0 form software only The Lacl(ner Group, Inc, Form REV-1513 EX (Rev. 9-00) EXHIBIT I STATE OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND I, DONNA M. OTTO Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 25th day of Auqust A.D., Two Thousand and Three, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of SWARTZ ARLENE J late of LOWER FRANKFORD TOWNSHIP (~'1', ~'1~'1', MI~) ' in said county, deceased, to SWARTZ JEFFREY LEE and SWARTZ RONALD K (LA~'I', ~'l~S'l', M±DD~) [L=~'I', ~'1~'i', MID~) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 25th day of August A.D., Two Thousand and Three. File No. 2003-00699 . Date of Death 8/11/2003 / ~/~ Registem S.S. # 194-26-6343 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL LAST WILL AND TESTAMENT ARLENE J. SWARTZ I, ARLENE J. SWARTZ, of Lower Frankford Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, revoking all other wills and codicils heretofore made by me. FIRST I direct the payment of my debts and expenses of my l~ast illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate, in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of lot so purchased to be vested in such person as my personal representative shall designate. Further, in this connection, I authorize my personal repreSentative to expend funds from my estate, in such a~ount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath my entire estate, of whatever nature and wherever situate, together with all insurance policies thereon, unto such of my children as survive me by thirty (30) days, per stirpes. LAW OFFICES ~HMAN & HESS CARLISLE, NSYLVANIA 17013 THIRD In addition to the powers conferred by law, I authorize my Executor~s), in his absolute discretion: 1. To retain in the form received, and to sell either at public or private sale any real or personal property. 2. To manage real estate. 3. To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification. 4. To exercise any option or rights arising from ownership of investments. 5. To compromise claims without court approval, and without the consent of any beneficiary. FOURTH I nominate, constitute and appoint my sons, Jeffrey Lee Swartz and Ronald K. Swartz, Co-executors of this my Last Will and Testament. I direct that my said Co-executors shall not be required to post bond or other security which may be required by the Commonwealth of Pennsylvania or otherwise. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of two (2) pages, the first of which bears my signature in the margin for the purpose of identification, this the /O~ day of O c.~o~.~ , 1980. Signed, sealed, Published and declared by the above named testatrix, ARLENE J. SWARTZ, as and for her Last Will and Testament, in the 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. ~HMAN & HESS COMMONWEALTH OF PENNSYLVANIA: :SS. COUNTY OF CUMBERLAND : Arlene J. Swartz, Robert L. O'Brien and Kevin A. Hess, the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the under- signed authority that the testatrix signed and executed the instrument as her last will, and that she signed willingly, and that.she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witnesses, and that to the best of their knowledge, the testatrix was at the time eighteen years of age or older~ of sound mind, and under no constraint or undue influence. Sworn to and subscribed before me this 10th day of October, 1980 CAIqLISt E ~3(it~0, CI ~i~Ef~L~?~O COLINT¥ Member, Penns¥1vania Associa£ion ol Notaries EXHIBIT Service COrporation ~44 Glenn Curtiss Boulevard Uniondale, New York H556.-ox44 October 22, 2003 Ms. Cheryl L. Baker Goldberg, Katzman & Shipman, P.C. 320 Market Street Strawberry Square P.O. Box 1268 Harrisburg, PA i7108'i268, RE: Arlene J. Swartz Dreyfus Liquid Assets, Inc. A/C No. 0039-0001911080 Ref. No. 20031020144937 Dear Ms. Baker: As per your request, the following is a summary of the Date of Death balance for the above referenced account. This account was established on June 8, 1978. The share balance of the Dreyfus Liquid Assets, Inc., A/C No. 0039-0001911080, as of August 11, 2003 was 4,187.810 at a price per share orS1. The total value as of the date of death was $4,188.43. The accrued dividend was $.62, and is included in the balance. If you have any questions regarding the above information, please feel free to speak with one of our service representatives toll free at 1-800-645-6561. The service department hours are Monday through Friday, 8 a.m. to 6 p.m., Eastern time. S~vfCerely,.,, .. /"-' .! Kenneth jeffer/son Correspondent Call Toll Free I-8oo-645-656I - In New York City Call 1-718-895-1206 Millsboro, DE 19g66 Mail code DE-MB-12 Phone: 888-502-434g Fax: 302-934-2955 Fax To.- Cheryl L Baker, CIA at Goldberg, From= Nancy Clagett Katzman, & Shipman, Fax.- 717-234-6808 Date.. January 22, 2004 Re: Estate of Arlene J Swartz Pages: 3 · Comments: Attached is a reply to your Date of Death information requested on the Estate of Arlene J. Swartz, I apologize for the delay and inconvenience this may have caused. Thank you for your anticipated assistance. If you have any questions, please do not hesitate to call me at free Cf 1-888-502-4349 using the date of death options. Have a great day! Nancy Clagett @ M & T Bank This communication contains information which may be confidential and proprietary. You may not use, disseminate, distribute or copy all or any part of this communication without the express consent of M & T Bank, AIIfirst Financial lnc. or their respec~ve subsidiaries or affiliates. In addition, if you are not the addressee (or are authorized to receive this information by the addressee), you are not authorized to receive or review the contents of this communication. If you have received this communication in error, please return it to M & T Bank at P.O. Box 1596, Baltimore, MD 21203 and delete any copy of this communication from your systems. Thank you. 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (302) 934-2909 F ax (302) 934-2955 November 4, 2003 Goldberg, Katzman & Shipman, P.C. Attorneys At Law 320 Market Street/Strawberry Square PO Box 1268 Harrisburg, PA 17108-1268 Re: Estate of Artene~l S~vartz Social Security: J 94-26-6343 Date of Death: August l l, 2003 Dear Sir or Madam: Per your inquiry dated October 15, 2003, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account ChecPa'ng Account Account Number 2677038727 Ownership (Names o20 Arlene d Swar~ Opening Date 09/01/67 Balance on Date of Death $10, 873.02 Accrued lnterest $ 0.00 Total $10,875.02 2. Type of Account Savings Account Account Number 15004200944343 Ownership (Names 020 Arlene d Swartz Opening Date 05/01/78 Balance on Date of Death $441.72 Accrued lnterest $ .08 Total $44 h 80 3. Type of Account IRA Account N~tmber 35004200215041 Ownership (Names oj~ Arlene J Swarm Opening Date 05/08/99 Balance on Date of Death $5,545.36 Accrued lnterest $ 1.13 Total $5,546.49 For further account information, closures and/or reimbursement of funds please call the }Iigh Street Carlisle Office at #717-240-4598. Records Management 'M&T Investment Group January 9, 2004 Ms. Cheryl L. Baker, CLA Goldberg, Katzman & Shipman PC 320 Market St Strawberry Square PO Box 1268 Harrisburg PA 17108-1268 RE: The Estate of Arlene J Swartz. Dear Ms. Baker: Pursuant to our telephone conversation, please find enclosed a copy of Ms. Swartz's November 2002 statement for her annuity policy with Western SOuthem Life Assurance Company. As we had discussed, Ms. Swartz had purchased her policy with Western Southern in November of 2001 through a representative of M&T Securities. Since most annuity carders provide only an annual statement of activity, only one statement was provided in November of 2002 for this policy before her death on August 11, 2003. If you need additional information, please contact me through our Customer Service group at 800-724-7788 (Option #3) with any further questions. Thank yOU. Sincerely, Rose-Marie A. Gross Operations Manager M&T Securities, Inc. Enclosures (1) M&T Securities, Inc. · One M&T Plaza · Buffalo, New York 14203-2399 Member NASD/SIPC · New York Stare Licensed Insurance Aflency Accessful.com Account Profile - Annuity Statement Page 1 of 1 ()Western.Southern Life Assurance Company Single Premium Deferred Annuity Prepared on 11/01/2002, Page 1 of 1 Owner SWARTZ ARLENE J 235 Mount Zion RD ~Ves~eft}-~o~ers J~e aporeciate$ Carlisle PA 17013-8919 yOU/' bu$i. qe$s. ~nuitant SW~TZ A~E~ J Contract N~er W 20603576 Contract Date 11/01/2001 Contract T~ NON-QUALIFIED Soc. Sec. No. 194-26-6343 * * * INFORMATION ABOUT YOUR CONTRACT ** * = > Total interest earned during any contract year will be impacted by any withdrawals, including systematic withdrawals, from the contract during that year. For example, if you select the systematic withdrawal plan, the interest you receive will be less than the amount indicated by the effective annual interest rate because interest is being paid out rather than accumulated, SUMMARY OF ACTIVITY 11/01/2001 through 10/3112002 Beginning Contract Value $ .00 plus Premiums Received Interest Credited* 27,000.00 /ess 1,161.00 Systematic Withdrawals .00 Partial Withdrawals .00 Surrender Charges .O0 Ending Contract Value 28,161.00 Surrender Value** 27,000.00 PREMIUM ACTIVITY Transaction Date Description Amount 11/01/2001 Premium $27,000.00 * The effective annual interest rate for the contract year indicated above was 4.30% and is 4.45% for the current year. The Pacesetter guarantees interest rates each year for two 5-year periods. During the first S-year guarantee period, the interest rate will increase by. 15% each year. The initial rate for the second 5-year guarantee period will be set at the current market rate at that time and will not be less than 3.00%. The interest rate will again increase by .15% each year. The minimum guaranteed interest rate in years 11 and later is 3.00%. ** Amount available after deducting any ~rj~_icable charges if you cancel your contract. For further intormation about your Pacesetter annuity ANNUITY OPERATION6 contract, including interest rates, contact your sales Western-Southern Life Assurance Company representative or call Annuity Operations. PO Box 2918 Cincinnati, Ohio 45201-2918 1-800-926-1702 https://www.accessful.corn/ddrint/viewDoc, asp?doc=3fe7693eb 160ddf0290b.png&reportlD=MOCS3916&vers 1/9/04 ACCOUNT REPORT RE: ESTATE OF ARLENE J. SWARTZ (SSN 194-26-6343) DATE OF DEATH: August 11, 2003 INSTITUTION: Ahold USA Account No. 1 Type o£Account: 401(k) Savings Plan Account No. ENV#MG009457 MG 35845T Opened Ownership Name(s) J~ C \w.~ % ~ Date current ownership established,ti, it I. I. c~ ~_ Balance of principal as of Date of Death %0 .,"'1~ ¼ , ~" Accrued Interest as of Date of Death (Not included above) Accrued Interest from 1/1/01 to Date of Death Beneficiaries Other comments: Account No. 2 Type of Account: Account No. Opened Ownership Name(s) Date current ownership established Balance of principal as of Date of Death Accrued Interest as of Date of Death (Not included above) Accrued Interest from 1/1/01 to Date of Death Beneficiaries "-fi~c'~q4~' "1 L. %c'~,c~c~r~. -'7c-r2,~_,4 Other Comments: VERIFIED AS TRUE, COMPLETE AND ACCURATE: ! 101776.1 3AholdusA Ahold USA, Inc. 401(k) Savings Retirement Savinas Stat m~_nt ~ .... ~-_ e ....... Plan for Hourly Associates d.~ua~ 7,200~- August ~1, #BWN FX"I'G MG 35845 D ARLENE J SHARTZ ~ For information about your account offer questions 255 HT. ZTON Roan about this statemert, you can call the toll-free CARLZSLE, PA 1701:5-8919 numberer 1-800-2~.9-4015. Your Account Summary Your Asset Allocation Beginning Balance $45,98520 Exchange In 5,813.$1 Exchange Out -5,813.61 J~ Stocks 64% Change In Market Value -5,188.35 ~ Bonds 34% Ending Balance $40,791~.85 '~,dditional In{ormation J'~ Short-term 2% · Vested Balance $40,796.85 * Dividend & Interest ~-'~:10~.~ Your Personal Rate of Return This Period -11.3% Year to Date 8.0% Your account is currsntly ~lJocated among the asset classes Your Personal Rate of Return is calculated wi~h a time-weighted specified above. Percentages and totals may not be exact due fen'hula, widely used by financial analysts k3 ~aicuJa[e inveslment to rounding. earnings. It reflects the results of your invesb'nent selections as The Additional Fund I nfon~ation section lists the allocation of well as any activity in the plan account(s) shown. Them ars other your blendsd funds. Personal Rat~ ot Return ~ormulas used that may yield different results. Remember that past performance is no guarantee of fulure results. Market Value of Your Account D~spJayed in this section is the value o~ your account tot the sr~temen~ period, in both shares and Shares on Shares on Price on Price on Market Value Marke~ Value Investment 12/31/~00.0 08/11/2003 12/31/200o 0,8/.11/2003 on 12/31/2000 on 08/11/200~_ Janus Adv Cap Appr I 0.000 301 ;:380 $27;33 $I 9;35 0.00 5,831,70 Janus Twenty Fund 175.659 0,000 $54.80 $:32.39 9,626.11 0.00 ............ ' ' - . .... Please read this sta~rnent carefully, Any error must be naported to Fldell:y Investments within 90 days. 0001 MG000001 0001 20031029 MG4K " Fidelity Investments, P,O. Box 770003, Cincinnati, OH 4~27T-0065 Page 10~/30/200~ 15:47 FAX ~]~03 Ahold USA, mc. 401 (k) Savings Statement Period; 01/01/2001 to 08/11/2003 Plan for Hourly Associates Market Value of Your Account (continued) Remember that a dividend payment to hJnd shareholders reduces the share price of the fund, so a decm~se in, the share price for the sfa. remer~t period does not necessarily reflect low~ fund performance. *Some of your investments are classil~ed as a Blended Fund Investment. Btencled Investmen{s may IllcluHe a mixture of stocks, bonds and/or short-term assets, Please refer to the "Additional Fund Information" section to determine the allocation of ~'our blended investments' underlying asse~, The asset breakdown of your portfolio is reflected in ~he pie chad in Ihs 'Asset Allocation" section. Your Contribution Elections as of 10/29/2003 This sectfon displays [fie funds in which your future c, on~ributions will be invested. Associate Company Associate Catch-Up Investment Voluntary Contributions Afre~-Tax Rollover Contribution, Fidelity Grow & Inc 20% 20% 20% 20% 20% Fidelity MIP II CI 3 20% 20% 20% 20% 20% Fidelity Puritan 40% 40% 40% 40% 40% Janus Adv Cap Appr I 20% 20% 20% 20% 20% Total 100% 100% 100% 100% 100% Account Activity by Source Use t~is section as a summary of trmlsa=tions that occurred in your account durfng the s~atement pedod. Associate Company ~Ftivitv Voluntary C_ontributions Rollover Total Beginning Balance $38,954.42 $3,~10~.09 $3,925.69 $4s,gss.20 Exchange In 4,959.63 393.41 460.57 5,813.61 Exchange Out -4,959.$3 -393.41 -460.57 -5,$13.51 Change In Market VaJue -4,442.86 -351.20 -394.29 -$,188,35 Ending Balance ,%34,511.$6 $2,753.89 $3,531.40 $40,796.85 Vested Percentage 100.00 % 100.00 % '[00.00 % Vested BaJance $:34,511.56 $2,753.89 $3,531.40 $40,796.85 Dividend & Interest $2,619.97 $209.50 $279.10 $3,108.67 Your Account Information If information below is incorrect, pJease contact Fidel~[y Invesrj'nents a! 1-8o0-354-7118. General Information Participant Status Deceased Employee Number 0194268343 Division 400 Delerrala Associate Voluntary 10% A Message From Ahold USA Jmpor~an! Reminder Regarding Investing in Company Stock When investing in company stocl<, ~t is impollant to consider the many factors that may influen~:e your investment strategy. These factors JncJude your porffoljo's diversification, your total financial picture, ~ncludJng other assets and investment holdings outside of the 401(k) plan, your time horizon, your risk toterance and, ~1 course, the company in which ycu may be investing. 0001 MGOQ0001 0001 20031029 MG4K FideJlty investments, P.O. Box 770003, Cincinnati, OH 45277-0065 Page 2 of 5 Ahold USA, Inc, 401(k) Savings Statement Period: 01/01/2001 to 08/11/2003 Plan for Hourly Associates A Message From Ahold USA (continUed) Developing an investment strategy and maintaining a diversified portfolio is an important part of any investment strategy. Diversification means that your investments are allocated among several different types of investments. Remember, though, that diversification does not ensure a profit or guarantee against a loss. For additional resources to help you develop your investment strategy, and a diversified portfolio, try the Asset Allocation Worksheet available through Fidelity NetBenefits. Simply log on to www.401 k,com, click on Tools, then Asset Allocation Worksheet. Fund Performance A summary of investment performance of al~ funds available in the plan. Funds you own are marked with an asterisk. Your holding pedod may differ from bhe time periods shown below. I Cumulallve% I AnnualTotalReturn~ l AveregeAnnuz,lToralRemrn,,~a~ofO6r~O/2OO3l lnce~,ion In. vestment (VR,~ Code) 3 Month Y'rD ~n~_ ~_ 2001 2~lO~J I Year 3 Year $ Year 10 Year life ) $8.32 31.57 ~Z, 9~ 6,66 11.37 -54.75 .29..,, N/A N/A -~4,$B Divers Intl (00325) 13.01 15.38 -9.37 -12.9~ -8.96 .0,87 -5,.",8 3.76 9.89 8.98 12/27/1991 Fidelity E~ulbJ lac (00023) 9.87 12.51 -17.16 -5.02 8.54 -~.19 -1,11 0,45 9.86 12.94 05/16/1966 Fidelily Grow & lac (00027)* 5.04 8.95 -16.08 -9.35 -1.98 -2.04 .?,~,~ -0,83 9.94 13.82 12/30/1985 Fidelity Low Pr SU( (00316) 16,64 19.$1 -6,18 26.71 18.83 0.~5 15.~7 9.5.3 1.~,01 16,66 12/27/1989 Fidelity Magellan (00021) 6.96 12.4~ -23.65 -11,65 -g.29 -0.23 -12.~,2 -0.96 8.71 19.21 05/02/1963 H & W Mid Cap Vel I (45766) 21.41 27.66 -9.44 N/A N/A ~,46 16,12 13.22. N/A 15.20 01/OZ/1997 Janus Adv Cap Appr! (91217)* 6,89 9,10 -15.85 -21.83 -16.34 -3.24 -1'~,~,1 3,44 N/A 11.49 05/01/1997 Janus Twenty Fund (99904) 7.¢J0 13.51 -24.02 -29,;.~0 ~32.42 2.33 -23,~;8 -2.99 9.$0 1~,83 04/30/1985 Janus Worldwide (99664) 10.54 8.99 -26.01 -~.88 -1S.87 -8,99 -20..(,5 · -3.46 9.23 10.86 o5/15/1991 Ld Abbott Der Grth A (917~,9) 20.00 ~,4g -2~),54 -6.98 -17.69 -6.19 -10.~ -Z,63 10,14 10.16 10/10/1973 MFS VaMa Fund A (2~430) 7.63 8.55 -13.34 -7.79 29,40 -3.95 1. ~ 4 , 4.46 , N/A 11,96 01/02/1996 MSIFT Value Adviser (9~94.3) 13,46 17.00 -22.61 4.27 23.20 -3,4~ 5,7'4 0.33 N/A 7.30 07/17/1996 Mu~Jal Disc~ve~ Z (45740) 8.74 12.Sl -9,06 N/A N/A 0.35 2.52 ' $,07 13,~Z 14.09 12/31/1992 RBC Mid Cap Equity I (45741} 13.20 16.85 -17.47 N/A N/A -1.76 -0.(2 6.39 , N/A 1~,76 06/01/1994 Spartan US Eq Index (00650) 8,46 13,66 -22.21 -12-05 -9.18 0,14 -11,2,3 Markel Indioes* -1.75 9.84 11.34 0~J17/1988 S&P ~00 Jrldex 8.49 13.73 -22.10 -11,89 -9,10 0.25 -11.,~.0 -1.61 10,04 N/A Wodd Index 9.68 13.36 -19.99 -16.~2 -13.18 -2.37 -12.~c5 ,-3.06 5.88 Fid Freedom 20(30 (00370) 1.61 3.91 -1.83 -0.09 3,98 5.11 1.(: 1 4.91 N/A 7,56 10/17/1996 Fid Freedom 2010 (00371) 3,98 7,88 -6.85 -4.34. 0.67 6,15 -2.12 4.28 N/A 8,19 10/17/1996 Fid Freedom 2020 (00372) 6.85 11,77 -13,71 -9.07 -3.03 4.64 -6,E3 2,53 N/A 7.36 10/17/1996 Fid Freedom 2030 (00373) 8.32 13.50 -17.31 -11,69 -5,07 2.90 -9.¢5 1.27 N/A 6.50 10/17/1996 Fid Freedom 2040 (00718) 9,46 14.87 -1~.66 -13.50 N/A 2.13 N/A N/A N/A -12.37 09/06/2000 Fldellty Puritan (00004)° $.E,0 8.82 -7,91 -1.05 7.77 3.79 ;~,C5 2,94 9.10 11.74 04/16/lg47 Managed Bond Fund (9351Z) 0.48 1.96 7.52 8 93 9 70 . ,c, . Markel Indices* - , 8 46 8. 3 6.88 N/A 7 01 09/02./1997 Dow Jones Index 9.60 1;~,20 -14,99 -5.39 -4.71 -0.50 -3.(~3 I 1.90 12.08 N/A Lippar Balanced Fund Index 5.46 9.12 -lo, 69 -3,z4 2_39 3.49 -1,80 1.98 7.73 N/A ~- Past performance is no guararltee of future results. Total returns are hJstorice, I and include the change ir ~ihare value and reinvestment of dividends and capital ge, itl distributions, i~ any. Cumulative returns are reported as of the periods shawl1. Lite of func ~gures are from commencement date to the period shown, Due to regulatory requiremanr~ the average anl3Llai total returns are reported as of the most recent calendar qua~er for 1:he periods shown and are calculated us ng a standard I:ormuJa. The figures dc flat include the effect of sates charge.~, i~ any, as these charges are waived for contributions made through your company's employee beneiit plan. if: sales charges were included returr s would have been lower, Each fund's share price (eXCept money market funds), yield, and relurl't will var,/, and you may have a gain or lois when you sell your shares, E~cl~ve on or about May 20, 2002. Fidelity Blue Chip Growth Fund will normally invest a~ least 80% of sssei$ in blue chip companies. Fidelity Diversified Inbamatfonal assesses a short-term trading fee et 1.00% for shares held lees than 30 days, Fidelity Low-Priced Stock Fund assesses a short-term trading fee el: 1.50% for shares held less than 90 d~tys. E~ectfve an or betor~ July 31,2002, Fidelity Low-Priced Sto~k Fund will normally invest at least 80% of its assets in row-priced stocks, ' The Hotchkis &W]ley M/d-Cap Value Fund is managed by Hotchkis and Wiley Capital Management, LLC, which provided the information tar this fund, Janus Adviser CaptiaJ Appreciation Fund, Class I Shares was tormaJly known as Janus Adviser CaDtJaJ A~: preclatlon Fund. Morgan S~anley Institutional Func~ Trust Value Portfolio - Adviser Class was formedy known as MAS Value, Portfolio - Adviser Class, F~delity is temporarily reimbursing a portion of Spartan U.S. Equity Index Fund's expenses. Absent such r~imbursement, returns would have been lower. 0001 MG000001 0001 20031029 MG4K ,, Fidelity {nvestments, P.O. Box 770003, Cincinnati, OH 4527-/-0065 Page 3 of 5 Ahold USA, Inc. 401 (k) Savings Statemenl Perlod: 01/01/2001 08/1 1/2003 Plan for Hourly Associates Fund Performance (oontinued) Strategic' Advisers, Inc., an affiliate of FMR, manages the Fidell~ Freedom Funds(R}, Strategic Advisers is temporarily reimbursing fund expenses. Absent such reimbursement, re~ums would have been lower. Lower-quality debt securities Involve greater risk,of default or price changes due to changes in the credit quality of the issuer. Non-FMellty funds are managed by non-Rdell~y on§ties. Please c,~nsult the prospectus, fact sheet, er $[ mmary Plan Description for more informazlon. If applicable, class of shams may vary. Please consult your Plan documentation for the specJlic class of shams available ~hrough your plan. Performance information for non-Rdelity funds was provided by a ~ird party. AEhough dale is car,,fully verified, accuracy and completeness cannot be guaranteed. , Managed Income Portfolio II Class 3 is not a mutual fund and is managed by Fidelity Management Trust Company. There are exchange between this fund and any other funds offanad through the plan which is conside~d a 'compeling fund". Managed Income Portfolio Cia,s 3 is not guaranteed by the manager or the Plan sponsor. * The Morgan Stanley Capital International Wodd Index (Worid Index), is an unmanaged index of over 1400 domestic and foreign stock prices and includes reinvest~nent of dividends. The S&P 500 is a registered sen/Ice mark of The McGraw-Hill Companies, Inc., and has been licensed fcr use by Fidelity Distributors Col'pOtation and its a~liaies, It is a wldety recognized, unmans,ged index of 500 U.S. common stocks, * The Dow Jones Industrial Average (Dow Jones) is an unmanr.~ged index of common stocks of ['he 30 m~jor industrial companies and assumes reinvestment of dividends, * The Lipper Balanced Fund is the average of the 30 largest mutual ~nd$ In the Upper Balanced univems. The LIpper Mutual Fund Indic~s are equally weighted indices of the large~ mutual funds within their respective investment objeclNes, adjusted for the reinvestmen~ of capital gains distributions and income dividends. The indices are cal(-,uiated dally. For more c~mple~e information about any of the mutual lunds or other investment op~ons availat)ls throu;/h the Plan, including fees and expenses, call or write Fidelity for a free mutual fund prospectus or/or additional Information on non-mutual funds. ]:~ead the information carefully before you make your investment choices. F/delily Investments Institutional Services Company, Inc. 82 Devonshire Street, Boston MA 02109. Additional Fund Information Use this section to determine the asset ~tlocalion of your blended [nveetments. Blended Invesff~en t Stocks Bonds Sh~rt-~erm FMelity Puritan 61% 34% 5% Blended investments must invest In more than one asset class. The blended illVestment asset allocation above reflects the ~tated neutral mix or, If not available, the asset mix reported by Momingstar, Inc.. for mutual funds or by inveslment managers ~¢ r non~nlutuaJ funds. A Message From Fidelity When the market in one asset class is down, another asset class is typically up, Spreading your assets among stocks bonds, and short-term investments can reduce the impact a down market has (cn your port/olio. Call your plan's toll free number o;' visit Fidelity NetBenefits® to review or change your asset allocation. Neither diversification nor asset allocation ensures a profit or guarantees against Joss. Fidelity Investments Institutional Services Company, Inc., ~2 Devonshire St., Boston, MA 02109 0001 MC000001 0001 20031029 MG4K " Fidelity Investments, P,O. Box 770003, Cincinnati, OH 45277-0065 Page 4 of 5 Kellev Blue Book Used Car Values Page 1 of 2 Kelley Blue Book THE T%srm R.OU"CE MARKET WATCH. [Enter emaJ, address ' ~b.com l~e~v Car Pric~Build a Car Blue Book Trade-in Report ~ Pennsylvania · October 15, 2003 Quali~y RaUngs :~ Owr~mhip Cost U~il C~r Retail 2001 Pontiac Grand Am SE Sedan 4D F~ee mice q~ote B~uy a New Car su~ a Used Car Buy a Used Car Sell Your Car List Your Car For Sale Online Financin~ Free Lemon Check ~surancei Auto Loans from 3.49% APR Lemon Oreck Engine: 4-Cyl. 2.4 Liter Insurance Quote wa~a~i Trans: Automatic VVarranty Quote Car Reviews ! Drive: Front Wheel Drive Payment Calculator Car Ir~.~,iews i Mileage: 28,000 Sell your car on eBay Motors DecJ~)n (~u~ I ~dviee I Equipment , Air Conditioning Tilt Wheel Single Compact Disc Free ~ Power Steering Cruise Control Dual Front Air Bags A_bout ~ i Power Windows AM/FM Stereo ABS (4-VVneel) iA)mai Power Door Locks Cassette Traction Control Shop over 50 models from Consumer Rated Condition: Good 7 great brands "Good" condition means that the vehicle is free of any major defects. The paint, body and intedor have only minor (if any) blemishes, and there are no major j'J~'o(~y Style ~ mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have JZip Code J ~ substantial treadwear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. ~ Trade-In Value $6,755 ~,,,,. ~,,,,~,-~,,,,.~Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost ~'"'"""i' ........ of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Get the latest B~lue Elook ~/a~.-,f~ ~'~,tch G_et a Priv_at~e Party _Va_lu_e Get Invoice & MSRP on N_e~ C~ars Kellev Blue Book Used Car Values Page 2 of 2 Which best describes your vehicle buying style? ('* I'm impulsive- once I decide what ! like, I'm ready to buy (" I like to think things through -the more information I can gather, the better. Copyright© 2003 by Kelley Blue Book Co., All Rights Reserved. Se~)ct 2003 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or omissions.(v.03094) GI~ (]OLDBERG, KATZMAN ~ SHIPMAN, P.C. Angnst 10, 2004 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle PA 17013-3387 Re: Estate of Arlene J. Swartz No. 21-03-0699 Madam: Enclosed please find our check in the amount of $23.33 as additional inheritance tax due. Very' truly yours. Mark B. Hammond P igl ara e a ~, Encl. 0421 3 COHNONWEALTH OF PENNSYLVANIA BUREAU OF INOIVZBUAL TAXES DEPARTHENT OF REVENUE BERT* 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 1712~-0601 APPRAISEflENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX DATE 08-09-200q F~ ESTATE OF SWARTZ ARLENE J DATE OF DEATH 08-11-2005 FILE NUMBER 21 05-0699 COUNTY CUMBERLAND JOHN DELORENZO ESQ '04AC~]~ 13 P2:27z01 GOLDBERG ETAL Amoun~ PO BOX 1268 HBG PA 17108 ~I'~HAKE CHECK PAYABLE AND REHXT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LXNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~-~:~-~-~--~-'(01-03} NOTICE OF ~NHERZTANCE TAX APPRA!S~HENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF SWARTZ ARLENE J FILE NO. 21 0~-0699 ACN 101 DATE 08-09-200q TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN (1) 118~940.00 NOTE: To insure proper 1. Real Estate {ScheduLe A) (2) qz187.81 credit to your account; 2. Stocks and Bonds (Schedule B) .OO submit the upper portion 5. Closely Held Stock/Partnership Interest {ScheduLe C) q. Nor~gages/Notes ReceivabLe {Schedule D) (q) .gO of this form with your (7) 7q~50q.$5 APPROVED DEDUCTIONS AND EXENPTIONS: 18,80q.05 187,8q9.55 NOTE: ~ an assessment was issued pravfously, lLnea 1~, 15 and/or 16, 17. 18 and 19 re~lect ~igures that /nclude the total o~ AL~ returns assessed to date. ASSESSMENT OF TAX: .00 x O0 .00 .00 X 12 .00 CDOOq019 .00 8,q52.2~ INTEREST IS CHARGED THROUGH 08-2~-200~ ~OTAL TAX CREDIT L 8,~52.25 AT THE RATES APPLICABLE AS OUTLINEO ON THE ~A~~TA~E[ 1.00 INTEREST AND PEN. ~ 22.33 REVERSE SIDE OF THIS FORM TOTAL DUE } 25.55 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX RECEIVED FROM: OFF~C~A~ RECEIPT NO. CD 004269 LORENZ JOHN ESQ GOLDBERG ETAL PO BOX 1 268 HARRISBURG, PA 17108 ACN ASSESSMENT AMOUNT CONTROL NUMBER ...... 101 $23.33 ESTATE iNFORMATION: SSN: 19426-6343 :ILE NUMBER: 2103 0699 ECEDENT NAME: SWARTZ ARLENE J ~ DATE OF PAYMENT: 08/13/2004 :,OSTMARK DATE: 08/13/2004 :OUNTY: CUMBERLAND DATE OF DEATH: 08/11/2003 TOTAL AMOUNT PAID: $23.33 REMARKS: CHECK//79523 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH SEAL REGISTER OF WILLS REGISTER OF WILLS GGo1. DBERG K~\TzM^N ~ SHIPMAN' p.C. P. egister of Wills , ~' mntx: Court~?usc Cumberlana *~ - (~ ' l Courthouse Squat Carlisle PA 17013-3397 BUREAU OF TNDTVTDUAL TAXES INHERTTANCE TAX DTVTSION DEPT. 280601 HARRTSBURG, PA 1712&-060! COMMONNEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE 'rNHERZTANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (01-05) JOHN DELORENZO ESQ GOLDBERG ETAL PO BOX 1268 HBG PA 17108 DATE 09-27-200~ ESTATE OF SWARTZ DATE OF DEATH 08-11-2005 FZLE NUMBER 21 05-0699 COUNTY CUMBERLAND ACM 101 Aeoun~c Reei~ed ARLENE J MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGTSTER OF NTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 1701:5 NOTE: To insure proper credi~c ~co your accoun~c, subei~ ~he upper por~:ion of ~chis fore .i~h your ~ax payeen~. CUT ALONG TH'rS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~.# 'rNHERZTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF SNARTZ ARLENE J FZLE NO. 21 05-0699 ACM 101 DATE 09-27-200~ THZS STATEMENT ZS PROVTDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAHED ESTATE. SHONN BELON TS A SUMMARY OF THE PRZNCZPAL TAX DUE, APPLZCATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, 'rF APPLZCABLE, A PROJECTED ZNTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-09-200q PRINCZPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 8,~55.23 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAZD (-) CD00~019 .00 06-0~-200~ 08-15-200~ CD00~269 22.55- TOTAL TAX CREDZT 8,~53.25 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ZF PAID AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~U/RED. ZF TOTAL DUE 1S REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THZS FORH FOR INSTRUCTIONS. )