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Home My WebLink About04-07-11 1505610140 '~ REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 2aosol INHERITANCE TAX RETURN 2 1 1 0 0 6 3 5 Harrisburg PA 17128-OS01 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 7 8 3 8 1 0 2 6 0 6 1 0 2 0 1 0 0 2 2 0 1 9 4 8 Decedent's Last Name Suffix Decedent's First Name MI M C L A U G H L I N M I C H A E L C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI M C L A U G H L I N N I C O L E M Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return 4. Limited Estate ^X 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 1 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPO NT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name ~ Daytime Telephone Number H E A T E R D R O Y E R E S Q U I R E 7 1 7 2 3 4 2 4 0 1 First line of address 4 4 3 1 N F R O N T S T R E E T Second line of address 3 R D F L O O R City or Post Office H A R R I S B U R G State ZIP Code REGISTER OF WILLS US - E'. LY - ~ ~ ~ Q -~ r `~ : ~, C`: ~ ` 1r-i ~ ta r- cn X ....! ~ ~ -. c`~ 7 DATE~ED ~'7 ~ ~ ~-} ~ 'z P A 1 7 1 1 0 Correspondent's a-mail address: HROYER(u~SASLLP.COM Under it is tru alties of perjury, I declare that I have ex rrect and complete. D ration o re fined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, r other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT OF PE ON RESP NSI N t7 ~~,.,. ;~ ~ ~ ~ DATE ADDRE / I~' /~~ I ~ ) Q y 1 ( 1 1 I SIGNAT E F PREPA R O THAN REPRESENTATIVE DATE ADDR ~ ~~ t ~ ~2u~T- c ~ ' , Ni~ZIS gy 26 . ~P ~- ~ rl l t C9 LEASE USE ORIGINAL FOR ONLY Side 1 L 1505610140 1505610140 ~ ~+ 1505610240 REV-1500 EX DecedenrsName: MICHAEL C• MCLAUGHLIN Decedent's Social Security Number 1 7 8 3 8 1 0 2 6 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .. 1 • • 2. Stocks and Bonds (Schedule B) .................................... .. 2• • 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ... .. 3. 0 . 0 0 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. ~ • ~ ~ 3 8 6 5 1. 2 8 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. ~ • ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ^ Separate Billing Requested h d l G S 7 2 4 3 2 1. 3 0 .... e ) ( c e u . ... 8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 6 2 9 7 2 . 5 8 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9• 3 3 5 7 5. 7 7 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 1 9 2 4 0 6 . 1 7 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 2 2 5 9 8 1. 9 4 12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. - 1 6 3 0 0 9 . 3 6 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. ~ 1 6 3 0 0 9 . 3 6 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICAB LE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15 0. 0 0 (a)(1.2)X.045 . 16. Amount of Line 14 taxable 0 0 0 ~ ~ ~ at lineal rate X .0 _ 16. • 17. Amount of Line 14 taxable 0 0 0 17 0• 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable ~ 0 0 0 ~ ~ at collateral rate X .15 18. • 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 0. 0 0 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 2I Io 0635 DECEDENT'S NAME MICHAEL C. MCLAUGHLIN STREETADDRESS -- - 7 WHITE OAK BOULEVARD __ CITY STATE ~ ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: t ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ._ B. Discounf 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 0.00 (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ 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? ......... ^ ^ 0 ^X 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [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 21 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 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 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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 0.00 Total Credits (A + B) (2) (3) REV-1504 EX ± (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE MICHAEL C. MCLAUGHLIN 21 10 0635 Schedule C-t or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted forsole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MICHAEL C. MCLAUGHLIN, LLC - A PENNSYLVANIA LIMITED LIABILITY COMPANY 0.00 MICHAEL C. MCLAUGHLIN WAS THE SOLE MEMBER OF THE LLC. THE ONLY DOD ASSETS OF THE BUSINESS WERE A RETAINER PAYMENT FROM GALLAGHER IN THE AMOUNT OF $2,120.00, A RETAINER PAYMENT FROM M & T BANK IN THE AMOUNT OF $1,139.70 AND THE BALANCE IN THE M & T BUSINESS CHECKING ACCOUNT IN THE AMOUNT OF $1,263.21. THE DEBT OF THE BUSINESS EXCEEDED $17,500.00 TOTAL (Also enter on fine (If more space is needed, insert additional sheets of the same size) RED/-1507 EX + (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER MICHAEL C. MCLAUGHLIN 21 10 0635 Ail property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MORTGAGE NOTE FROM ROBERTA M. KLEIN TO MICHAEL MCLAUGHLIN DATED 0.00 FEBRUARY 28, 2002 IN THE AMOUNT OF $12,356.50. REAL ESTATE SECURING NOTE WAS FORECLOSED ON. BORROWER HAS NO MEANS OF PAYING THE NOTE PERSONALLY AND THE ESTATE HAS DETERMINED THAT THIS DEBT [S UNCOLLECTIBLE. THE COST TO PURSUE BORROWER WOULD EXCEED ANY REASONABLE PAYMENTS RECEIVED FROM BORROWER. TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX ± (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MICHAEL C. MCLAUGHLIN 21 10 0635 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PROCEEDS FROM SALE OF 2006 HUMMER H3 16,000.00 2. ~ PROCEEDS FROM SALE OF 2002 LEXUS ~ 19,500.00 3. (LPL FINANCIAL INDIVIDUAL ACCOUNT 1226-1481 I 479.88 4. ~ UNUM LIFE INSURANCE POLICY REFUND ~ 1,140.98 5. (CAPITAL BLUE CROSS PAYMENT OF AMBULANCE CLAM I 1,250.00 6. IPA TURNPIKE EZPASS REFUND I 16.50 7. I ALLSTATE INSURANCE REIMBURSEMENT I 213.92 8. (ALLSTATE INSURANCE REIMBURSEMENT FOR TOWING I 50.00 TOTAL (Also enter on line 5, Recapitulation) ~ S 38,651.28 (If more space is needed, insert additional sheets of the same size) REV-1510 EX± (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MICHAEL C. MCLAUGHLIN 21 10 0635 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDETHENAMEDFTHETRANSFEREE,THEIRRELATIDNSHIPTODECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. LPL SEP IRA ACCOUNT 4655-4658 11,035.20 100.00 11,035.20 BENEFICIARY -NICOLE MCLAUGHLIN, SPOUSE 2. PSECU SAVINGS ACCOUNT 178381026-SI 200.04 100.00 200.04 NICOLE M. MCLAUGHLIN ADDED 1/19/10 4. ING - 401 K RETIREMENT ACCOUNT NO. 878343-178381026 13,086.06 100.00 13,086.06 OPENED 11/05/07; HELD INDIVIDUALLY BENEFICIARY -ESTATE OF MICHAEL C. MCLAUGHLIN TOTAL (Also enter on Line 7, Recapitulation) ~ $ 24,321.30 If mon; space is needed, use additional sheets of paper of the same size. REV-1511 EXt (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MICHAEL C. MCLAUGHLIN 21 10 0635 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. WEIDMAN FUNERAL HOME 8,154.38 2. PRINCE OF PEACE -FUNERAL RECEPTION 1,750.00 3. STAPLES -FUNERAL PROGRAMS 192.78 4. STRAWBERRY PATCH -PHOTO FRAME 15.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions; Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: SMIGEL ANDERSON & SACKS 8,934.50 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) 3,500.00 Claimant NICOLE MARIE MCLAUGHLIN Street Address 7 WHITE OAK BOULEVARD City MECHANICSBURG State PA Zlp 17050 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees: REGISTER OF WILLS 478.50 5 Accountant Fees: BROWN SCHULTZ SHERIDAN & FRITZ AND JOHN SHERIDAN 8,602.50 6. ~ Tax Return Preparer Fees: 7. CUMBERLAND LAW JOURNAL -LEGAL ADVERTISING 75.00 8. THE SENTINEL -LEGAL ADVERTISING 208.78 9. ALLSTATE INSURANCE AUTO INSURANCE PREMIUM PAYMENT 1,165.32 10. PENNDOT HUMMER REGISTRATION 58.50 11. SUTLIFF -HUMMER INSPECTION 42.35 12. ALLSTATE MOTOR CLUB -TOW HUMMER 60.00 13. SUTLIFF -INSTALL BATTERY 181.16 14. SUNOCO -GAS FOR HUMMER 26.00 15. M & T SAFETY DEPOSIT BOX DRILL FEE 131.00 16. EXECUTOR TRAVEL & LODGING TOTAL (Also enter on Line 9, Recapitulation) S 33.575.77 If more space is needed, use addfional sheets of paper of the same size REV-1512 EXg (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MICHAEL C. MCLAUGHLIN 21 10 0635 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PSECU PERSONAL SERVICE LOAN (L1) 1,523.62 2. PSECU AUTO LOAN (L13) 14,798.70 3. PSECU AUTO LOAN (L12) OWNED JOINTLY WITH NICOLE MCLAUGHLIN 6,455.46 4. HAMPDEN AMBULANCE SERVICE 1,250.00 5. REFUND OF SERS PENSION PAYMENT RECEIVED AFTER DOD 584.33 6. 2009 PER CAPITA TAXES 36.00 7. MILTON S HERSHEY MEDICAL CENTER -MEDICAL BILL 380.35 8. AQUA SPECIALISTS -POOL SERVICE 110.78 9. CENTER CITY DENTAL CARE 343.00 10. AMERICAN EXPRESS CREDIT CARD 371388734972003 7,805.73 11. CHASE ONE CREDIT CARD 5490921050226391 1,149.81 12. BANK OF AMERICA CREDIT CARD 4888936024412797 1,560.44 13. CAPITOL ONE CREDIT CARD 4791242318483792 2,243.52 14. CITI MASTERCARD 5424180547283975 3,095.28 15. ADVANTA CREDIT CARD 5475843771759014 9,785.07 TOTAL (Also enter on Line 10, Recapitulation) $ 192 406.17 If more space is needed, insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MICHAEL C. MCLAUGHLIN 21 10 0635 Decedent's Name Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. QUANTUM IMAGING MEDICAL BILL DOS 4/07/10 45.00 17. 2006-2010 FEDERAL, STATE & LOCAL INCOME TAX LIABLITY 131,073.00 18. BANK OF AMERICA CREDIT CARD 5329041277201643 4,960.43 19. AMERICAN EXPRESS CREDIT CARD 371732396381005 5,205.65 SUBTOTAL SCHEDULE I 141,284.08 GRAND TOTAL SCHEDULE 1 $ 192,406.17 REV-1513 EX+ (p1-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MICHAEL C. MCLAUGHLIN 21 10 0635 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. NICOLE MARIE MCLAUGHLIN Spousal 0.00 7 WHITE OAK BOULEVARD MECHANICSBURG, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. i w r I r 3105-8-5/WilllHDR/tmc 21Z5l10 9:45 Alvl ~' _", LAST WILL AND TESTAMENT ~ rv -- ~ ~ _ ~ OF ~ '-~ =~ ~ ~ -~ ~ - -, , -.; . McLAUGHLIN MICHAEL C ~,. ? ~ , ~ - --, . 1 ~ _ ,;r ~ "j '7 C: ~ ,1 I, MICHAEL C. McLAUGHLIN, presently of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all Wills and Codicils previously made by me. MARITAL STATUS I declare that I am married to NICOLE MARIE McLAUGHLIN and that all references in this Will to my wife are references to her CHILDREN I have three (3) children, now living, whose names and dates of birth are as follows: IAN C. McLAUGHLIN born November 17, 1970 DEVYN L. McLAUGHLIN born July 9, 2001 GRAYSN M. McLAUGHLIN born May 25, 2004 All references in this Will to my children include only the children named above. PET ARTICLE I I give my dog, SARGE, to my wife, NICOLE MARIE McLAUGHLIN. PERSONAL PROPERTY ARTICLE II I give all of my household furnishings and tangible personal property to my wife, NICOLE MARIE McLAUGHLIN. My wife is encouraged to consider any requests for household furnishings or tangible personal property that my son, IAN C. McLAUGHLIN, or my nieces and nephews may request, but she is not bound to honor any such request. RESIDUE ARTICLE III I give the rest, residue and remainder of my estate to my wife, NICOLE MARIE McLAUGHLIN. EXECUTOR ARTICLE IV A. Aapointment. I appoint my brother, JOSEPH P. McLAUGHLIN, JR., as the Executor of this Will. In the event of the death, resignation, renunciation or inability to act of JOSEPH P. McLAUGHLIN, JR., in that capacity, then I appoint JOHN W. FROMMER, presently of Mechanicsburg, Pennsylvania, as the Executor of this Will in his place and stead. In the event of the death, resignation, renunciation or inability to act of JOWN W. FROMIVIER in that capacity, then I appoint my wife, - NICOLE MARIE McLAUGHLIN, as the Executrix of this Will in his place and stead. _ Page 2 of 8 Pages B. Bond. No bond or other security shall be required of any Executor or Executrix appointed in this Will. C. Compensation. The Executor or Executrix shall receive reasonable compensation for his or her services performed as determined by the Court in which this Will is admitted to probate. EXECUTOR POWERS ARTICLE V I give my Executor in addition to and not in limitation of the powers given by law or by other provisions of this Will, the following powers with respect to settlement of my estate, to be exercised from time to time in the discretion of my Executor without further order or license of the Register of Wills or of any court: A. Investments. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries, to compromise claims, and to sell any property at public or private sale; B. Securities. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; C. Litigation. To engage in litigation and compromise, arbitrate or abandon claims; Page 3 of 8 Pages D. Distributions. To make distributions in cash or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; E. Tax Returns. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; F. Loans. To pay off any loans I may have taken against any life insurance policies owned by me that remain unpaid at the time of my death; G. Borrowing and Encumbering. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; H. Property Management. To manage, control, repair and improve all real and personal property; I. Insurance. To procure and carry at the expense of the estate, insurance of the kinds, forms and amounts deemed advisable by the Executor to protect the estate and the Executor against any hazard; J. Employment of Attorneys, Advisors and Other Aeents. To employ any attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed necessary in the discretion of the Executor, and to pay from the estate reasonable compensation for all services performed by any of them; Page 4 of 8 Pages K. Business Operation. To conduct alone or with others any business in which I am engaged or in which I have an interest at my death, with all the powers of any owner with respect thereto, including the power to delegate discretionary duties to others, to invest other property held hereunder in such business and to organize a partnership or corporation to carry on such business; L. General. To do all the acts, to take all the proceedings, and to exercise all the rights, powers and privileges which an absolute owner of the property would have, subject always to the discharge of his fiduciary obligations. The enumeration of certain powers in this Will shall not limit the general or implied powers of the Executor. The Executor shall have all additional powers that may now or hereafter be conferred on the Executor by law or that may be necessary to enable the Executor to administer the provisions of this Will, subject to any limitations specified in this Will. NO ALIENATION ARTICLE VI No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. NO CONTEST ARTICLE VII If any beneficiary or remainderman under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate or in the Page 5 of 8 Pages ,...~~ estate of the Trust given to that contesting beneficiary or remaindemlan under this Will is t revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary or remainderman had predeceased me without issue. LEGALITY OF ARTICLES ARTICLE VIII If any provision of this Will or of any codicil thereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully operative and effective so far as it is possible and reasonable. TAXES ARTICLE IX All estate, inheritance and succession taxes, together with any interest and penalties ,thereon, payable as a result of my death and imposed with respect to any property, whether or not disposed of by this Will, shall be paid out of the residue of my estate. Page 6 of 8 Pages IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of eight (8) typewritten pages, includinng this attestation clause, to be executed, declared and published this .~~-~"~~ day of 1,(;'l ~` , 2010, at River Chase Office Center, 4431 North Front Street, Harrisburg, Pennsylvania. ~~ ~ I t.l.('~ZCi~I' ( 11~~~ ~ [C~ ~.,~ (SEAL) MICHAEL C. McLAUGHLIN U Signed, sealed, published and declared by the above named MICHAEL C. McLAUGHLIN, Testator, as and for his Last Will, in the presence of us and each of us, who, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. t5 I~ i ~~~~~i`~1 ~~;r:c~~~ I ~ ~ .~ ~~'~~ 4'~~1. ~s'11.~~Y1 Residing at Residing at Residing at t-~"~~ ~ltLu1 ~,t~1G~ ~ ~ Cl r' ~~3~ 3 ~~r~~ L.i ~I Y:~_ ~~ { , ~'G~~C~=,~~ ~ ~~ I`1 C !5 Page 7 of 8 Pages ~,: ':~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS. We, MICHAEL C. McLAUGHLIN, the Testator, and I`j~ .f' .~~ ~~. ~,~~~~ '~ ~ /~ ll ~+ , ~`.~~ ~;~r~;~.rs1 l . C. ~~~~ and ~~~ ~ U ~ 1(~~r'~'1 • ~'~'- ~ the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness and that to the best of his or her knowledge the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. MICHAEL C. McLAUGHLIN Witness Witness ~ ~ Witness Subscribed, sworn to and acknowledged before me by MICHAEL C. NIcLAUGHLIN, the Testator, and subscribed and sworn to before me by- J Ic - ~ .' -~~- ~. ~~ ~%'`LCl ! 7 ~ 1 ~ ~~'~,. ~` t 1 . _~(i.~`~.1. and ~-=~ ~ ~ . ~ ~ ~. ~ - ~ > >~l i-i'?'1 ,witnesses, this ,~~~ day of p ,~~,;+~.(~~l _, 2010. !~l --.~.~~ n~ C'. ~~u~ti~~ .~~: Notary Public '- (SEAL) Page 8 of 8 Pages 1010007142 DEPAR17uEWT USE ONLY RCT•101 PAGE 1 OF 6 PA CORPORATE TAX REPORT 2 O O 7 N 1120 N 1120S N 112oc N 1120E N 1120H N 1065 Y Joao N other STEP A STEP B Tau Year Bep. X X 01012 0 0 7 Regulated Inv. Co. X X N First Report Tau Year End. X X 12 312 0 0 7 SZ-53 Week Filer X X N Koa/El P Cndk Address Change X X ~ N File Period Change STEP C Corp Tax AcoouM D X X 5 8 8 0 4 2 4 F.a.nlFrl~ XX 81588003 sustntm AotlNty cod. X X 5 419 9 0 Corparationlrarrr• XX MICHAEL C• MCLAUGHLIN, LLC Address t.bn 1 X X P. 0. BOX 7 9 0 Addrsss Lb~e 2 X X cley XX HARRISBURG sea XX PA nP XX 17108 STEP D ~ Tmt u.wnq, n btlmaad Paym•rd• c. R•atrkbd iron Tax Report i Cnd11s on D•posk CndRs CS/FF 0 0 0 LOANS 0 0 0 CNI 0 0 0 TOTAL 0 0 0 STEP F: Refund (Transfer Method Select one of the following options: A Y Tow tnnshr or ardit B N Toth rNund ara~an STEP G: Corporate Officer (Sign afflrmatbn bebw) NAME PHONE E-MAIL XX N XX N XX N c•loul•tloe: ~ to'P/1 Dept ar~ i :nua' Aminus a minus C 0 0 0 0 0 0 0 0 Made Payment ~a EFT N FORM BARCODE 1 hereby aalna rstd•r pataNNs pasald•d by Iwr that this report (ineludYq any aceampanybp aeh•dul•s and saam•rdsl has bean tapaebt•d by are and a the bast of my knowiad0a and bNIM Y a trras, •orr•ot ~d eompNb report N prepared by • pati eon othn than dw Ids ds•1•ratlon Y bead on aw Mroratalion oivrldoh M has Corponb t3fffcar SlpraturNDsb ,Y,~,~,~ USE WHOLE DOLLARS ONLY 1D10007242 ACCOUNT ID 5880424 TAX YEAR END 12312007 NAME MICHAEL C" MCLAUGHLIN, LLC RCT-101 PAGE 2 OF B PA CORPORATE TAX REPORT 2007 SECTION A CSIFF OLDEST PERIOD TAX PERIOD TAX PERIOD FIRST BEGINNING ENDING BOOK INCOME YEAR 1 01012003 12312003 27996 InvemnerKmLLC XX N YEAR 2 01012004 12312004 -24887 HoldlnpCompeny XX N YEAR 3 01012005 12312006 4811 FamNyFarm XX N YEAR 4 01012006 12312006 101 YEAR 5 0 YEAR 6 0 YEAR 7 D CUR YR D1012007 12312007 477 IdHOLE DOLLARS ONLY 2. T07AL BOOK INCOME (sum of Income for ell tax periods up to, but not aver 5 years total) 2 84 98 ~. DIVISOR (In years and in part years rounded to three deamal pieces) See Insbudions 3 5 " 0 0 0 4. Divide Line (2) by Line (3) 4 17 0 0 S. AVERAGE BOOK BiCONE -Enter Line (4) ar >f Line (4) is less than aero enter "0" 5 17 0 0 B. Divide Line (5) by 0.095 6 17 8 9 5 7. Shareholders' equity at the END of the current period 7 9 2 7 4 e. snarehadsrs' equity at the BEGINNNG of the wrrent period 8 8 7 9 7 9. K Line (7) is more than twice as yrept ar less than half as much as Llne (8), add 9 9 2 7 4 LMes (7) snd (8) end divide by 2.08~ervvise ertiter Line (7). 10. NET WORTH -Enter Llne (9) or M Une (9) Is less than zero enter'0" 10 92 7 4 11. Multiply Line (10) by 0.75 11 6956 1s. Add Llnes (a) and (11) 12 24851 13. Divide Line (12) by 2 13 12 4 2 6 14. s150.000 valuation dedualon 14 -150D00 1 S. CAPRAL 8TOCK VALUE -Line (13) less Line (14) but not less than "0'. H 10096 Taxabb, 15 0 enter Line (15) on Line (17). 18. Proportion of taxable assets or spportioriment proportion (From Sclbdule A-1, Line 5) 16 0 1T. TAXABLE VALUE -Multiply Lins (15) by Line (18). H less than zero, enter'0" 17 0 18. CAPfTAL STOCKIFOREKiN FRANCtNSE TAX -Multiply Line (17) by 0.00389 18 0 Total Bepinnkry of Taxabb Year Assets 1 D 6 2 4 Total End of Taxable Year Assets 9 2 7 4 1010007242 .rraseaZ.ooo 1010007242 1D1DOD7342 ACCOUNT ID 588D424 rAx YEAR END 12312D07 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 3 OF 6 PA CORPORATE TAX REPORT 2007 SECTION B: Bonus Dspncistion BueMMes Tnat X X N 1. Current Year Fed. Deprec. d 168k Prop. 1 D Sdkkatlon Only X X N 2. Currant Year Adj. for Dkp. of 168k Prop. 2 D 81ngle Member LLC X X Y 3. other Adjustments 3 D Mulct-IMmbsr LLC X X N (Must Attach Schedule C-3 N claiming PAS X X N bonus depreciatlon) Taxable BuIINn OsN~s X X N SECTpN C: CORPORATE NET INCOME TAX 1. Income « Loss hen federal Tatum on a separs6s campsny back ], 0 2. DEDUCTION8: A. Corporate DMdends Rsoelwd (Pram Schedule C,2, LM 8) 2 A 0 B. krtsrest on U.B. Securltles (GROSS WT lea EXPENSES) 2 B 0 G Curr Yr. Addtl. PA Deprec. plus Adjust. for Sale (Atddnd Schedule C-3) 2 ~ D D. Other (Attached Schedule). Sse Mtructlons 2 D D TOTAL DEDUCTIONS - Sum d (M thrargh (D) 2 D 3. ADDRIONB: A. Taxes Imposed on « messund by nd income (Agadred Schedule) 3 A D B. Tax Prsferena- kerns (Attached copy d Federal Form Ib'18) 3 g D C. Employment bgnfiw Payment Cndk Adjustment (Aflached Sdadule W) 3 E 0 D. Current Year Bonus Dspreeletlan (Attached 8chedide C~3) 3 D D E Other (At~ched Schedule) See iratructlons 3 E D TOTAL ADDRION8 - Sum d (A) tl~rough (E) 3 D 4. Income « Loss wkh Pennsylvanle Adjusbnenb (Llne 1-Liras 2 t Uns 3) 4 D 5. Tohl Nonbueinas Insane (« Lees) 5 0 8. Income (« Lea) to be Apportloned (L.Ine 4 - Line ~ 6 D 7. Apportlarment Propor8on (ham Sdndule C-1 Lpfe ~ 7 0 8. Inarme (« Lars) Apportioned to PA (I.bs 8 x Line 7) 8 D 9. Nanbuslness income (« Loos) a8oaied to PA 9 0 10. Taxable Inarme (« Lose) aPoer ApparBonment (LNn 8 ;Line 9) 1 D 0 11. Toby Net Opsrating Lays Deductlaf (from RCT-103) pn not 11 D exceed 13,000,000 or 12 112% d liras 10 12 D 12. PA Taxable Income (« Loss) (Liras 10 -Line 11) 13 D 13. Corponb Net Income Tax (Line 12 x .08QSn 1D10007342 ,reesaooo 1010007342 USE WHOLE DOLLARS ONLY 1010007442 ACCOUNT ID 5880424 TAX YEAR END 12312007 NAME HICHAEL C . MCLAUGHLIN, LLC RCT-101 PAGE 4 OF 6 PA CORPORATE TAX REPORT 2007 SECTION D: LOANS TAX 1. Did this corporaton hsve a fiscal officer resident in PA and paying interest on indebtedness a the ooporation? X X 2. Did this corporation have indebtedness outstanding to individual residents and/or partrierehipe resident in Panratylvania? X X 3. Did this corporation have indebtedness autstandirrp held by a trustee, spent or puardlen for a resident individud X X taxable in Its awn right or by an executor or administrator of an estate wherein the dsoedent was a resident of Pennsylvania? List ouhtandlrrp 4rdaltNdnets. Attach seperete schedule ff additlonal apace required. Inbnat Amoua IrKanat Rata TaobN Valve 0 0 0 TAX INDEBT X X 0 0 0 0 0 o I.oANS TAX x x 8CHEDULE A-1: Apportionment Schedule For Capital 8tock/ForaiBn Franctrsa Tax (Include Form RCT-102, RCT 105, or RCT 106) ThrN Factor 8lrgla Faesor Property-Pq 1 A 0 1 C 0 NumereOor 4 A Property-Total 16 0 Denominator 46 Payroll-PA 2 A 0 2 C 0 PayroN-Taal 2 B 0 Sales-PA 3 A 0 3 C 0 Apportionment 5 Saiss-Total 3 B 0 ~'~~ 8t:HEDIJLE C-1: Apportionment Schedule For Corporate Nat Incana Tax (Include Fonn RCT 106) Three Facrtor Sin81a Factor Property-PA 1 A 0 1 C 0 Numerator 4 A Property-Taal 1 B 0 Denominator 4 B Paynoii-PA 2 A p 2 C 0 Payroll-Total 2 B 0 sales-PA 3 A 0 3 C O Apportionment 5 sates-Taal 3 B 0 ~~+ L 1010007442 N N N 0 0 0 0 0 0 0 0 1010007442 7V~828 2.000 10100D7542 ACCOUNT ID 5880424 TAX YEAR END 12312007 NAME MICHAEL C. MCLAUGHLIN, LLC RCT-101 PAGE 5 OF 6 PA CORPORATE TAX REPORT 2007 SECTION E: CORPORATE STATUS CHANGES Out d Existsnod out d Existence X X N Withdrawal Date X X (Find Report) `Date d Distribution d X X ~ No Assets PAAssats to distribute PA Corporations: Report date business activity passed and date assets were distributed. Foreign (Non-PA) Corporations: Report date badness actlvlty in PA ceaesd and date PA assets were dbUbuted. 'Schedule d Dispositbn d Assets MUST be compbted and fibd with the PA Corporate Tax Report. Has the corporation solo or transferred in bulk 51 X or more d any d the fdkxwing dasess d assets: X X N any stock d goods, wares, merchandise d any kind, ttxtures, mactrkrery, equipment, buildings or real estate. H so, please provide the name and address d the purchaser. (Attach aeperate schedub ff addltlond space required.) Purchaser Name X X Address Line 1 X X Address Line 2 X X City X X State X X Zip X X SECTION F: GENERAL MIFORMATION QUESTIONNAIRE Brief Description d corporals activlly in PA PUBLIC SERVICE /LOBBYING SERVICE S Brief Description d corporate activity N / A outside d PA List other states in which taxpayer has activity state d incorporation X X P A Incorporation Date X X D 1012 0 0 3 1. Does any corporeton, individual, or other business entity hold dl or a majority d the stock d this corporation? 2. Does this corporatkxr own all or a majarky d stock In other oorporetlons4 M yes, complete Schettub X. 3. Is this taxpayer a partnership that elects >p f1e federal ta~aas as a corporatiorr4 4. Has federal government changed taxable income as originally reported for any prior period far which reports d change have not been flied in PAZ N yes: First Period End Date: X X Last Period End Dale: X X XX XX XX XX XX N Y N N N Accounting Method-Federal Tax i2afum N Attract Y c;aslr N other Accounting Method-Financial Sta<enrents N Attract Y Cash N Other L 1D10007542 1010007542 J ~r~ses z.ooo 1010007642 ACCOUNT ID 5880424 TAX YEAR END 12312007 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 6 OF 6 PA CORPORATE TAX REPORT 2007 SCHEDULE OF REAL PROPERTY MI PA (Attach separate schedule ff addMional space required.) Own/R~nt StrNt Addrsss Ctty County KOZACOEZ OWN 6135 WESTOVER DRIVE MECHANICSBURG CUMBERLAND N CORPORATE OFFICERS SSN Lsst Nams Flrs~t Nams MI PresidenUManapin9Partner XX 178381026 MCLAUGHLIN MICHAEL C vice President X X secretary X X TreaaurorlTaz Marreger X X TAX PREPARER'S NAME AND ADDRESS Mail to Pnctitaner X X Y FederalElN XX 25-1644159 Firn,l,~,f1e XX BROWN SCHULTZ SHERIDAN FRITZ AddressUne~ XX 210 GRANDVIEW AVENUE Addross Line 2 X X shy XX CAMP HILL g~ XX PA Z;p X X 17D11 Taa Pnpanxs SlpnaturnlDabs NAME JOHN P• WEIDMAN PHONE E-MAIL 1010007642 ,v.eees.ow 1010D07642 REV-eeo (12-08) SCfil9dule L -Balance Sheets for Single Member Limited 11abi<l7y Companies When the income fs reported on the Pere~rtai Insane Tax Rettxn of ilia Member Bednnir~ aF Yssr End of Year a b c d 1• a Trade notes and ccourris receivable 10 384. 9 274. b. L wance bad 3. 1 Dries 4. U. Government O ations 5. Tax-exam t securities O her curr nt assets attach schedule 7. M e and real estate loans Other irwestme attach ule Builds sand of de reciable 2 eoe. 2 so Le ccumulat de n 2 eo9. 2 003. 10. De letable L s accumul tad d ' n 11. L nd net a am n 1 I Ible a am ble i 200 1 2 0, Leas accumulated am 960. 240. 13. Other a ae ached 1 Total Asaets LiabNities and a ble 6 9 74. 1 M a es notes bo s ble in less then 1 17. Other curr M liabiliti attach schedu i 827. >t01r! 18. M a s rates bonds ble rn 1 or more 19 21. Other I sillies a ch s Member'S Ca ital ACCOUrrt Total tiebNlties and Ca 797 10 62 9 274. 9 274. c k -~et~rtcNia6on af~lncome,fiha~).per 8oak~~acome (i~S~j Per'1 1. Net Inoome (loss) per books ........ . 2. Income included on Federal Schedule C or Federal Schedule E and not included on books this year (itemi~) ........... . 3. Expenses recorded on books not included on Federel Schedule C or Federal Sdredule E this year (item¢e) .............. . a Depreciatan $ 5. Income included on books not inGuded on Federal Schedule C or Federal Schedule E this year (kem¢e) a Tax Exempt Interest $ 6. Expenses recorded on Federal Schedule C or Federal Schedule E and not irxiuded on books this year (~em~) ...... . a Depreciation $ b. Travel aril Entertainment $ 400. 7. Add Lines 5 and 6 8. Income Loss Federal Schedule C or 4. Add Lines 1 through 3 ............. Federal Schedule E. Line 4 less Line 7.. 144 797. - Recorx~lliatiomof;lAilenltber~S~,~Aux~otarti .. 1. Members Capital Account-Beginning .............................. . 2. Capital Contributed during Tax Period ............................. . 3. Net income for Tax Period ................................... . 4. Withdrawals of Capital During Tax Period ........................... . 5. Member's Capital Account-Ending (Lines 1+2+3..4) Must equal Schedule L, Column D, Line 20 .......................... . 7Y4021 1.000 8 797. 144 397. 43 9 0. 9 274. 26715H K371 V07-8.4 MICHAEL C. MCLAUGHLIN, LLC 810588003 FORM 1065, SUPPORTING SCHEDULES _-=-=~-n=====_____ = __===~=M-~ s= _----~------___----~-__----- SCHEDULE L - LINE 17 - OTHER CURRENT LIABILITIES BEGINNING M ENDING~ _~~_ ==-______~______~~ __ ====u=== _--------------- --------------- SALES TAXES PAYABLE 1,827. NONE ---~---- --------------- TOTAL OTHER CURRENT LIABILITIES 1 827. NONE nocoes ,.ooo STATEMENT ~kl 26715H K371 V07-8.4 MICHAEL C. MCLAUGHLIN, LLC 810588003 PENNSYLVANIA LLC FOOTNOTES ==--=_a~=====__------==a=co====_~es===___=_s=__--_ =c==s==a=====___~_ =:_ ~_ RECONCILIATION OF RCT-101, PAGE 2 CURRENT YEAR BOOK INCOME: BOOK INCOME FROM 01-01-2007 TO 12-31-2007 $144,397 LESS DISTRIBUTIONS TO MEMBER ( 143,920) RCT-101, PAGE 2, CURRENT YEAR BOOK INCOME $ 477 DISTRIBUTIONS TO MEMBERS SATISFIES THE MATERIAL PARTICIPATION REQUIREMENTS OF SECTION 469 OF THE INTERNAL REVENUE SERVICE CODE OF 1986 AND THEREFORE ARE DEDUCTIBLE IN COMPUTING BOOK INCOME FOR PA CAPITAL STOCK TAX PURPOSES. STATEMENT #1 ~xxoes ,.aoo 26715H K371 V07-8.4 J PASchedufe C o~o31~DO23 Prdk a Law Fran Bushtsa a Prafsselon (SOLE PROPRIETOR~iIP) PA-40 C (10-07) ({) 2 ~ QZ.._ Include wqh Fenn PA-Ae, PA-YS9fPM6 or PIr4t r Nartte d owner a shown on PA me rshrm: Owner's MICHAEL C MCLAUG LIN Social Security Number 178-38-1026 A. Main business a - PU AFF RS ud a service - B. Business Nsme - M CHAEL C . MCLAUGHLI LC C. Em Identlflcatlon Number D. Busfnessaddress(nuntbarandabeet)~sQs_~Q~_79Q__________________________ C c State andzlPCode- ISBURG PA 17108 81-0 88003 E Method s) used to value Closing inventory. FII in the appropriate boot Sales Tax Llceras Number (a aDD) (1) Cost (2) ^ Lower of cost a market (3) Other (H other, attach e~lwtadon) F. Accounting method. F9f in the appropriate boot (1) ©Cash (2) ~ Accrual (3) ^ Other (seed(y) - ............... Ya N o Fedora ~~ cads d Was them any change in detennfnfng quantitie, ~, a valuations , , , , , , , between opening and closing imrentor)It ff "Yes," wbmit eo~ianatlon. - H. Did you deduct eo~erises for an oflioe in your home? .................... X I. ff the business is out d aodstenoe ss d the and d the ottrreM tax_Zre_ir, ~ in this boot.... . 1. a. Oroe reosipts a sales ............................. 1 a. 17 4 2 9 0 . ~':' - b. Returns and allovvanees ... ..................... t b. c. Balance (subtract Line 1 b from Line 1 a), , , .. . .............. ........... 1 c• 17 4 2 9 0 . 2. Cost d goods sold andlor operafbns (ScheduM C-1, Line 8) ............................ 2, 3. Gross profit (wbtract Line 2 Iran Line 1 c), _ ........... 3. 7 4. a W ro Itlier busie na aet~x h ~A~ In ~ of oPerstlott•1 klrafr ~.t.~.~ . .. 4. B. Advartlsinp ................... . 7. Amortization .................. . 8. Bad debts from eels or services ......... . 9. Bamk .................. . 10. Car and truck e>~ettses ............. . 11. Commissions .. .... . 12. Cost depletion but not percentage depletion , , , 13. a. Regular depredatlon , , , 13. b. Section 179 ao~ertss , ..... . 14. Duos and publia8ons .............. . 15. Employee benefit programs abler than m Line 23 , , 16. Froight (not included on Schedule G1) , , , , , , , 17. Inaunanoe ......... ..... . 18. Interest on business indebtedrtsss , , , , , , , 19. Laundry and deanirip , , , , , , , , , , , , , 20. Legal and professional service . , , 21. Management fees .............. . . 22. Office wpplias .. ....... ..... . 23. Pension and profit-sharing picots for employees , , 24. Postage . .................. . . 25. Rent on business property , , 28. Repairs ..................... . 28. Supplies (not t~audad m ea+.ow. ct). . 29. Terre . . . . . ....... . 30. Telephone. .... , 31. Travel and entertainment , , 32. Utllities ............ . 33. Wages ............ . 34.Other eoopense (seedy): e. --- S~~ 1 ------ b. d.------------------ ------------------ s.------------------ f. ------------------ p'------------------ h. ------------------ i. ------------------ j'------------------ k ------------------ 34. Total other et~enses . , , ... . 35. Total E>grensea. (sae I.Ma s eragR 34) . 38. tieduae eMpanses by the total buelnea txsdMs dNmad ttar «amD~. y~ tne~. PMrrnts Cawk) Ort your PA-~0. 29,893. 37. Total Adjusted Eotpenses deductions Subtract Line 36 from Line 35. ---------------------------•37. 2 9 8 93 . 38. Net Droflt a bss (wbtmct tins 37 from l.lne 5). M a net toes. fill In the box. Entx the result on your PA taK tetum. .Loss 38. 14 4 , 3 9 7 . L D?D3110D23 SIDE1 D7D3110Q23 7rsssa ~.ooo PA Schedule C PASO C (10-07) (I) PA Ol~ARTMB~IT OF REVENUE 0703210021 Name of owner as shown on PA ta: return: social seamy Numtnr 1. Inventory d beginning d year (K dMaeM from last years dosing ktivenlory, kxdude aerplanatbn 1. 2. e. Purdtases ............................ 2a. b. Cost d kerns wkhdram for pareonN use . . . . . . . . . . . . . .. 2b. c. Balance (subtract Lkls 2b from lJne ?a) .. .. .. 2c. 3. Cost d labor (do not indude salary paid to yourself or subcorgraaor fees) ... .. ... 3. 4. Materials and .. .. .. .. ... .. .. .. 4. 5. Other ousts (krduds schedule) .......................................... 5. B. Add UnM 1, 2c, 3.4. and 6 .. .. .. 6. 7. Inventory at and d yew .. .. .. .. ... .. .. .. .. 7. 8. Coat et need: rid rviJer eeanaena rrdYfarl tier 7 *ern r1r al Ear nr..ed ee err 1_ un. 7 . - R PA PR taw does not psnnh the bonus dspredaUort elections added to the Internd Revenue Cods (NriC) fn 2002 and 2003. PA PIT law Iknits RC Section 179 current ao~ensing to the e>~srtsing alktwed at the time you placed the asset into scrubs a the eo~ertsing In effect under the IRC of 1988 es amended January 1, 1997. Fdr each asset, you must also report strafyht-Ik-e dspredadon, unless not using an optional accelerated depredation method. You need the amount of straight-Nne depredation to take advantage of Pennsylvania's Tax BeneNt Fouls when you sap the asset. See the PA PR Gukts for the Taos Benefit Rule. 1. Total Sectlon 179 depredation (do not include In llama below) , , , , , , , ~ 1. 2. Less: Sectlort 179 depredation included in Schedub G1 ............................. - 2. 3. Balance (Subtract Line 2 from Line 1) Enter hero and an Part II. Line 13b ...................... - 3. 4. Other depredation: BuBdlnps . .. . . . . . .. . . . . FumHurs and ibNuras .. . Transportaeon equiprtlart . . . . . . Machinery and other equlpmerd . . Other(spedfy) _-- ---____-- DEPRECIATION ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ 5. Totals (add sg Line 4 amour-ts), . on oroaise a oa a oamp in prbr yeas a.pr.ertfon 8. Any depredation included in Schedub C-1 .................... ................ . 7. Balance (sutrtrect Line 8 fiom Line 5) Enter here and on Part I!, Line 13a ................ ..... ~ ~ 7. ~ 3 , 8 7 6 0703210021 SIDE 2 D703210021 7Y48441.~0 MICHAEL C MCLAUGHLIN 178-38-1026 SUPPLEMENT TO PENNSYLVANIA SCHEDULE C sassesmssxssassssssas:ssssssszso:ssxsss:ssseaxsxsxsa~aassasssssssassaae=sssxs=s BUSINESS NAME - MICHAEL C. MCLAUGHLIN LLC a==sxesasssssax saxosmsssosmass=sxasssesxsa=saxaxmxsx==se=:sssas OTHER EXPENSES AMOUNT ------------------------------------------------------------ ------------ OFFICE-IN-HOME EXPENSES BUSINESS EXPENSES INTERNET SERVICE BANK FEES MISCELLANEOUS SALES TAXES TOTAL OTHER EXPENSES TO SCHEDULE C, LINE 32A 4,430. 4,335. 1,406. 90. 55. 5,759. 16,075. STATEMENT 1 4OY1WH K371 V07-8.2 JPW-25548 1D10DD8173 DEPARTMENT USE ONLY RCT-101 PAGE 1 OF 6 PA CORPORATE TAX REPORT Z Q Q 8 ~ ~ 20 N ~ ~ 2os N » zoc N ~ ~2oF N » 2oH N 1085 r/ ~ oao Y other N STEP A STEP B Tax Year BeD. X X 01012 D D 8 Regulated Imr. Co. X X N First Report X X N Tax Year End. X X 12 312 0 0 8 52-53 W eek Filer X X N KOLEIP Credit X X N Address Change X X N File Fbriod Change X X N STEP C Change Fed Group X X N Corp Tax Accourn ID X X 5 8 8 0 4 2 4 Federal EIN X X 815 8 8 0 0 3 susirnss Aditrtty Catty X X 5 419 9 0 CorporationNnna XX MICHAEL C• MCLAUGHLIN, LLC Address Lins 1 X X P• 0. B O X 7 9 D Address LJns 2 X X cRy XX HARRISBURG sun XX PA zlp XX 171D8 srEP t:: P. r~m.at STEP D A Tax LMWNg/ e. tiatlmatad PaymaMs C. Rsatrknd AAaka Chadc this arnOUM Cdeutatlon: payatNa a •PA Dpi d rwanur from Tax Report 3 Cndlts on DspoaR Cndifs Amba+s a minor C CS/FF D 0 0 D 0 LOANS D 0 0 0 D CNI 0 D 0 0 0 TOTAL p D p 0 0 Made Payment Via EFT N STEP F: Refund (Transfer Method Select one of the following options: A Y Tow vans. d awK B N Tote ratans d awk STEP G: Corporate Officer (Sign affirmation below) NAME PHONE E-MAIL FORM BARCODE I hanby attina under panaMlas praaeribad by law that this sport IN~eM+dhrY ~Y accomparrybp achaduNs and stanmanis) tw bean aaamNrad by nrs and n eha bast of my krtowNdps and baNaf Is a erw, cornet and eamphits npoR K pnpand by • par- son Debar than tM tax hN dsel~ion r based on a0 Information of which Ire has Corporate Otfic~r SlgnaturNData eras~as.txb USE WHOLE DOLLARS ONLY 1010008273 ACCOUNT ID 5880424 TAX YEAR END 12312008 NAME MICHAEL C. MC LAUGHLIN, LLC RCT-101 PAGE 2 OF 6 PA CORPORATE TAX REPORT 2008 SECTION A: CS/FF ` OLDEST PERIOD TAX PERIOD TAX PERK FIRST BEGINNING ENDING BOOK INCOME YEAR 1 010120D4 12312004 -24887 InwsbnantlnLLC XX N YEAR 2 01012005 12312006 4811 HddinpCompany XX N YEAR 3 01012006 12312006 101 FamllyFann XX N YEAR 4 D1012007 12312007 477 YEAR 5 D YEAR 6 0 YEAR 7 0 CUR YR 01012008 12312D08 -9005 WHOLE DOLLARS ONLY 2. TOTAL BOOK INCOME (sum of income for all tau periods up to, but not over 5 years total) 2 - 2 8 5 0 3 s. DIVISOR (in years and in part years rounded to three deamat places) See Instructions 3 5.0 0 0 4. Divide Line 2 by Line 3 4 - 57 01 5. AVERAGE BOOK INCOME -Enter Line 4 or H Line 4 is less than zero enter "0" 5 D 6. Divide Line 5 by 0.095 b 0 7. sharehdders' equity at the END of the current period 7 2 6 9 a. Shareholders' equity at the BEGINNING of the current period 8 9 2 7 4 9. If Line 7 is more than twice as great or less than ha-F as much as Line 8, add 9 4 ? 72 Lines 7 and 8 and divide by 2. Otherwise enter Line 7. 10. NET WORTH -Enter Line 9 or if Line 9 is less than zero enter "0' 10 4 7 72 11. Multiply Line 10 by 0.75 11 3579 12. Add Lines 6 and 11 12 3 57 9 13. Divide line 12 by 2 13 17 9 0 14. 5150,000 valuation deduction 14 -15 D D D 0 15. CAPITAL STOCK VALUE -Line 13 less Line 14 but not less than "0". H 100% Tamale, 15 0 enter Line 15 on Line 17. 16. Proportion of taxable assets or apportionment proportion (From Schedule A-1, Line 5) 16 0 17. TAXABLE VALUE -Multiply Line 15 by Line 18. If less than zero, enter "0" 17 0 1B. CAPITAL STOCKIFOREKs'N FRANCHlBE TAX -Multiply Lfne 17 by 0.00269 18 0 Total Beginning of Taxable Year Assets 9 2 7 4 Total End of Taxable Year Assets 2 6 9 L 1010008273 evaseas.ooo 1010008273 101D008373 ACCOUNT ID 5880424 TAX YEAR END 12312008 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 3 OF 6 PA CORPORATE TAX REPORT 2008 SEC110N B: F3onus Depnciatlon f3usMress Trust X X N 1. Current year fed. degree of 188k prop. 1 D Sollcltation Only X X N 2. Current year adj. for dup. of 188k prop. 2 D Slnph Member LLC X X Y 3. Other adjustments 3 0 Multl-Member LLC X X N (Must attach schedule G3 if daiminp PA•S X X N bonus depreciation) Taxable FiuYtdn Game X X N SECTION C: CORPORATE NET INCOME TAX 1. Income or loss from federal velum an a seperab company bads 1 0 2. DEDUCTIONS: A. Carponh dividends ncelved (From ScMduM C,2, Line 6) 2 A 0 B. Interest on U.S. securltles (GROSS INT Mss EXPENSES) 2 B D C. Curr yr. addti. PA deprec. Pius ad)ust. for saN (attacMd Schedule C~1) 2 C 0 D. Otirer (sttached scheduN) Bee instructlons. 2 D 0 TOTAL DEDUCTIONS - Sum d (A) titrough (D) 2 0 8. ADDITIONS: A. Taxes Imposed on or measured by net Income (attacMd scheduM) 3 A D e. Tax Preference Items (attached copy of FederM Fam 1624) 3 B 0 C. Employment incentive paymerrt credit adjustment (attacMd 8eheduk ~ 3 C 0 D. Currant year bonus depnclallon (alFaclwd 8dreduk Cam) 3 D 0 E Other (attached schedule) Ses Instrucllorrs. 3 E D TOTAL ADDITION8 - Sum d (A) through IE) 3 0 4. Income a lass with Pennsylvania adjustments (Line 1 - Llns 2 + Line 3) 4 0 S. Total nonbuskNSS Income (a loss) S 0 8. Income (a loss) to bs apportioned (Line 1 • Line ~ 6 0 7. ApportlonmaM proportion (tram 8cheduk C-1 Llrre 5) 7 0 8. Income (or loss) appor'tlorred b PA (Line B x Line 7) 8 p 9. Nonbuslness income (or loss) allocated to PA 9 D 10. Taxable Income (or loss) after apportimment (Una 8 + Line !) ], 0 0 11. Total Nst Operating Loss deduction (from RCT-10Sj cannel ], ], 0 exceed 18,000,000 or 12 112% of Line 10 12 0 12. PA taxable Income (or loss) {Line 10 • Lyre 11) 13 0 1 S. Corporate Net Income Tax (Lfns 12 x .0986) L 1010008373 BY48652.oro 1010008373 USE WHOLE DOLLARS ONLY 1010008473 ACCOUNT ID 5880424 TAX YEAR END 12312008 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 4 OF 6 PA CORPORATE TAX REPORT 2008 SECTION D: LOANS TAX 1. Did this corporation have a fiscal offkor resident in PA and paying interest on fndebtedness of the corporator? X X 2. Did this corporation have indebtedness outstanding to individual residents and/or partrlerships -esident in Pennsylvania? X X 3. Did this corporation have indebtedness outstanding held by a trustee, agent or guardian for a resident individual X X taxable in Its own right or by an e~aecutor or administrator of an estate wherein the decedent was a resident of Pennsylvania? List outstard4tg Ntdebtedrtass. Attach separate schedule if additional space is required. Inanst Amount Iitbrpt Rob TarabN Ydw 0 D 0 TAX INDEBT X X 0 0 D 0 D 0 LOAJds TAX X X SCHEDULE Art: Apportionment Schedule For Capital Stock-Foreipn Franchhe Tsx (Include Forrn RCT-102, RCT-105, or RCT-106) Three Factor Sirpls Factor Property-PA 1 A 0 1 C D Numerator 4 A Property-Total 19 0 Denominator 4 B pay~hpA 2 A D 2 C 0 Payra+-total 2 B 0 ~_pA 3 A Q 3 C 0 Apportionment 5 Sales-Total 3 B D proportion SCHEDI~E C-1: Apportionment Schedule For Corporate Nat Income Tax (Include Form RCT-106) Three Factor Simple Factor Property-PA 1 A D 1 C 0 Numen~tor 4 A Property-Total 1 B D Denominator 4 B Payrdi-PA 2 A 0 2 C 0 Payroll-Total 2 B 0 sales-PA 3 A 0 3 C 0 Apportionment 5 sales-Total 3 B D Proportion N N N 0 0 0 0 0 D 0 0 1010D08473 evaezez.ooo 1010008473 J 1Q1a008573 accouaT ID 588424 TAx YEAR END 12312008 NAME MICHAEL C• MCLAUGHLIN, LLC RCT-101 PAGE 5 OF 6 PA CORPORATE TAX REPORT 2008 SECTION E: CORPORATE STATUS CHANGES Out of Erdstencd Out of F_rdstence X X N Withdrawal Date X X (Final Report) 'Date of DisUibution of X X 4!; No Assets PA Assets to Distribute PA Corporations: Report date business activity ceased and da6a assets were distributed. Foreign (Non-PA) Corporations: Report date business activity M PA oeased and date PA assets were distributed. 'Schedule of Disposttion of Assets MUST be completed and tiled with the PA Corporate Tax Report. Has the corporation sold or transferred in bulk 51 % or more of arty of the following losses of assets: X X N any stock of goods, wares, merchandise of any kind, fixtures, machinery, equipment, buUdngs or real estate. If so, please provide the name and address of the purchaser. (Attach separate schedule if adcsitlonal space is required.} Purchaser Name X X Address Line 1 X X Address Line 2 X X Cry X X State X X ZIP X X SECTION F: GENERAL INFORMATION QUESTIONNAIRE Brief description of corporate actlvRy in PA PUBLIC SERVICE /LOBBYING SERVICE S Brief description of corporate activky N / A outside of PA List other states in which taxpayer has activity State of Incorporation X X P A incorporation Date X X 01012 0 0 3 XX N 1. Does any corporation, individual, or other business entity hold all or a majority of the stock of this corporation? X X Y 2. Does this corporation own all or a majorty of stock in other corporations? If yes, complete Schedule X. X X N 3. Is this taxpayer a partnership that elects to fib federal tames as a corporation? X X N 4. Has federal government changed taxable income as originally reported for any prior period for which reports of change X X N have not been fled in PAZ !f yes: First Period End Data: X X Last Period End Date: X X Accounting Method -Federal Tax Retum N Accrual Y ca5n N other Acc~unting Method -Financial Statements N Accrual Y cash N other I,...~ 1010008573 BY48632.000 1010008573 J 1010008673 ACCOUNT ID 5880424 TAX YEAR END 123b2008 NAME MICHAEL C• MCLAUGHLIN, LLC RCT-101 PAGE 6 OF 6 PA CORPORATE TAX REPORT 2008 SCHEDULE OF REAL PROPERTY IN PA {Attach separate schedule if additional space is required.) OwnlRent SKeat Address Clly County KOZ/KOEZ OWN 6135 WESTOVER DRIVE MECHANICSBURG CUMBERLAND N CORPORATE OFFICERS 33N Laat Nams First Nama MI President/ManagingPartner XX 174381026 MCLAUGHLIN MICHAEL C Vice President X X Secretary X X 7reasuror/Tax Manager X X TAX PREPARER'S NAME AND ADDRESS Mall to Practitioner X X Y FederalElN XX 25-1644159 Firmt+lame XX BROWN SCHULTZ SHERIDAN FRITZ Addressiinel XX 210 GRANDVIEW AVENUE Address Line 2 X X city XX CAMP HILL state X X P A aP XX b7011 Taz Pnpanr's SlgnaWn/Dab NAME JOHN P- WEIDMAN PHONE E-MAIL 1010008673 av+sssz.ooo 103000x673 J Pennsylvania Schedule L -Balance Sheets for Single Member Limited Liability Companies when the Income is Repotted on the Persortaf Income Tax Return of the Member 1. Net income (bss) per books , , , , , , , , , , 2. Income included on federal Schedule C, federal Schedule E or federal Sd~edule F and not included on books this year (i<emae) , , , 3. Expenses recorded on books not included on federal Schedule C, federal Sct>edule E or federal Schedule F this year (kem¢e) , , , , , a Depreciation $ Begimina of Year End of Year a b c d income included on books not included on federal Schedule C, federal Schedule E or federal Schedule F this year (itemize) , , , , Tax Exempt Interest $ Expenses recorded on federal Schedule C, federal Schedule E or federal Schedule F and not included on books this year (itemi~), , , Depreciation $ b. Travel and entertainment $ e67. Add Lines 5 and 6 , , , , , , , , , , , , , , Income or loss on federal Schedule C, federal Schedule E or federal schedule F. 4. Add Lines 1 through 3 ............. Line 4 less Line 7 , , , , , , , , , , , , , , , 130 6 s. Schedule .M-2 - Reconciliation of Member's Capital Account 1. Member's beginning capital account .............................. . 2. Capital contributed during tax perod .............................. . 3. Net income for tax period .................................... . 4. Withdrawals of capital during tax period ............................ . 5. Member's ending capital account (Lines 1+2+3-4) Must equal Schedule L, Column D, Line 20 ........................... . 8Y462f 2.000 9 274. 1 9 816. 138 821. 269. 26715Ii K371 V08-8.1 Schedule M-~ - Recondiatron of Income (Loss) per Books to Income (Loss} per Return MICHAEL C. MCLAUGHLIN, LLC 810588003 PENNSYLVANIA LLC FOOTNOTES ^_.~-.=c~===e==o=s.mx~-oe==-osaa~.oes .oc.~o=~.=c= ==s=scsoc =__~=-=-~c==s===-=__ RECONCILIATION OF RCT-101, PAGE 2 CURRENT YEAR BOOK INCOME: BOOK INCOME FROM 01-01-2008 TO 12-31-2008 LESS DISTRIBUTIONS TO MEMBER 129,816. -138,821. RCT-101, PAGE 2, CURRENT YEAR BOOK LOSS -9,005. DISTRIBUTIONS TO MEMBERS SATISFIES THE MATERIAL PARTICIPATION REQUIREMENTS OF SECTION 469 OF THE INTERNAL REVENUE SERVICE CODE OF 1986 AND THEREFORE ARE DEDUCTIBLE IN COMPUTING BOOK INCOME FOR PA CAPITAL STOCK TAX PURPOSES. STATEMENT 1 8%X063 3.000 26715H K371 V08-8.1 PASchedule C 0803110022 Profit or Loss From Business ar ProMsion PROPRIETORSHIP) P A•40 CC ( PAaIrARrMIMr OF r1EVE1tUE 2 ~ Include wkh Form PA-l0, PM2eSIPA$6. or PI. 41 oFFla~tusE Orar Name of owner as shown on PA tax return: Owner's MI C C MCLAUGHL N Social Security Number 17 - 3 8 -10 2 6 A. Main business - UB C FF IRS ud or service - B. Business Name - M CHAEL MCLAUG LIN C C. Em 1 r Identlftcatxm Number D. Business address (number and street) ~~4s_ $Q~__7_9~-------------------------- C c State andziPCode- I URG PA 710 81-0588 03 E Method(s) used to value closing inventory. F(N in the appropriate boot Sates Tax Llcenae Number (K orppliable) (1) ~ Cost (2) ~ Lower of cost or market (3) Other (ff other, attach eo~lanation) F. Accounting method. Fill in the appropriate boot (1) ©Cash (2) ^ Accrual (3) ~ Other (sped - ............... Yes No Federal NAICS Code to Was there any change in determining quantities, mats, a' valuations ............ X between opening and Dosing inventoryT If'Yes; submfteltplanation. H. Did you deduct expenses for ~ office in your home? . ................. .. X I. If the business is out of ao~rtoe, fill in tltis boot 1. a. Gross receipts or sates .............................. i a. t o v . ~ ~ v . b. Returns and aUoNrartcxs ............................. 1 b. c. Balance (subtract Una 1b from Una 1a) . ...................... ............. . 2. Cost of goods add and/or operatlorts (Schedule C-1, Ltne 8) ...................... ..... . 3. Gross profit (subtract Una 2 from Una 1c).. 4. ()they Itfeom® (submk atetemeM} Inclde 4olerest fiom aocoums recahgrble. busineo» cFoeekhq accourots . and other bualnesa accounts. Alq froduds sales of aparatbrgl asaeta. Ses Ins4udions Booklet. ` Advertising 6 28. SuppYes tea Induelae m eeneul. Gt). . ................... . Amortization 7 29. Taxes, , , , ...... . ........ ......... . Bad debts from sobs rX services 8 30. Telephone ... .... ... . ......... . Bank ct>er es 9 31. Travel and entertainment , 1 7 3 5 . g . enses ca- and truck ex 10 4 4 3 9 . 32. utiltties .............. p . Commissions 11 ............ . 33. Wages . .. .. . ercentage depbtlan letion but not 12 t d C ..... ... 34. Other expenses (specify): p . os ep reciation ul R r de 13 2 7 01. a S T 1 T M .. .. a p . a. eg se ction 179 eo 13 b S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ b' ~ . . e ........ ublications 14 D and ------------------ a , p . ues rograms atherthan an Une23 es benefit lo 15 Em d• , p . p y ht (not inctuded an Schedule C-1) i 18 F ------------------ e. ....... re g . 17 n I ------------------ f• . nsura ce ssindebtedttess sin t b 18 t I ------------------ 9• ....... .. eres on u e n . in d 1 L d d __________________ h. g ............. .. esn ry an c 9. aun feesionaiservicea l L d 20 r 1 39 ________________-- I• , .......... an ega . D o M t f __________________ ~' ees ....... ......... anagemen 21. Otftc su tks 22 ------------------ k ...... . e pp rofit-sharing plans for empkoyees ion and Pen 23 . . . 34. Tots{ other expenses . 19 8 2 0 . ... s p . Postage 2a . . . 35. Total Expenses. load I~nea s tnrouen sa,) . 3 0 2 3 4 , ...................... . Renton business property 25 38. Reduce expenses by the total busiroasa . . .. i 26 R credits elatmed tror., Emproymfant tnowrtire PaYR~enk Creak) on your PA•~e. rs . epa 27. Subcontractor fees 37 Total adjusted expenses (Subtract Une 38 from Una 3 5).----------------------------------•37. 30 ~ 2 3 4 . _ 38. Net profit or loss (subtract Line 37 from Lkre S) If a net foss fill in the boot Enter the restolt on your PA tax return. , Logs ~ 38. 12 9.816 . 0803110022 SIDE 1 0803110022 ~~..~ aYSe~31.L00 J PA SCh@dlJl@ C OBD3210D20 PA-40 C (10-08) (1) PAO~AArYBir OF R!N&aa: of owner as shown on PA tax realm: Social Securky Number 1 7f2-RR-1 n7 1. Inventory at bepfininp of year (N dkferartt from la6t years Gosinp inventory. inchrda eon .. 1. 2. a Purchases ......... ............... 2a. 0. Cost of trams wkhdrawn for peracnel uss 2b. o. Baknce (subtnwt Line 2b from Lkrs 2a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2C. 3. Coat of labor (do not Include salary paid to yourself a subeontroclor fees) .. .. 3• 4. Materials and supidfss . .. .. .. .. 4. 5. Other costs ('srdude schedule). .. 5• 6. Add Lines 1.2c. 3, 4 ar~d 5 . . . . .. . . . . . . ... . . . . . . . . . . . . . . . . . . . .. . . . . .. 8. 7. Inventory at end of year . .. . . . . ... . . . .. .. . . . . . . .. . . . 7 PA PIT law does not permR the bonus depredation electrons added to the Internal Revenue Code pRC) in 2002 and 2003. PA PR law limits IRC Section 179 curratt etq>ensing to the e~ensing allowed at the time you placed the asset into service or )n effeG under the RC of 1986 as amended Jan. 1, 1997. For each asset, you must also report straight-one depreciation, unless not using an optional accelerated depredation method. You need the amount of straight-Hne depredation to take advantage of Pennsylvania's Tax Benefit Rule when you sell the asset See the PA PR Guide for the Tax Benefit Rule. 1. Total Section 179 depredation (do not indude in items below) , , , ......... - 2. Less: Section 179 depredation inducted in Schedule C-1 ......... .... ... ............. - (a) a. Omer depreciation: BuNdirrps . . . . . .. . . . . . . . Fumkure and Ibdures , Tranaportatlon equipment . Machinery and Darer aquipmenl. . Other(apadfy) __-- --_----- __ DEPRECIATION _______ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ 5. Totals (add all Line 4 amourrts), , , , a oMrsr bash Depractatwn eipwed or oa a eanp allowable in prior years dspncistlon 6. Any depreciation inducted in Schedule G1 , , .... .......... ......... . (D) 7. Balance (subtract Line 8 from Line 5) Enter here and on Part ll, Line 13a . ............... .. - I 7. 1 G , ~ y 1 080321D020 SIDE 2 08D321002D 8Y4544 {.000 MICHAEL C MCLAUGHLIN 178-38-1026 SUPPLEMENT TO PENNSYLVANIA SCHEDULE C BUSINESS NAME - MICHAEL C. MCLAUGHLIN LLC 5_____________~ __=______________________________=~_____~_______ OTHER EXPENSES AMOUNT ------------------------------------------------------------ ------------ OFFICE-IN-HOME EXPENSES BUSINESS EXPENSES INTERNET SERVICE BANK FEES MISCELLANEOUS SALES TAXES TOTAL OTHER EXPENSES TO SCHEDULE C, LINE 32A 4,203. 5,467. 1,199. 79. 164. 8,708. 19,820. ____________ STATEMENT 1 40Y1WH K371 V08-8.4 JPW-25548 101DDD9115 Df3?ARTNIDYT' USE C1NLY A CORPORATE TAX REPORT ZOO 9 G A = 1120 B = 1120S C = 1120C D = 1120E E = 1120H F = 1065 G = 1040 H =Other STEP A STEP B Tax Year Beginning X X 01 D 12 D D 9 Reguhated Im. Co. X X N First Report X X N Tax Year Ending X X 12 312 D D 9 52-53 Week Eller X X N KOLEIP/SDA Credk X X N Address Change X X N File Period Change X X N crtange Fed Grottp X X N . srEP c Corp Tax Atxotrnt ID X X 5 8 8 D 4 2 4 FederalElN XX 81588DD3 Business Adrvily Code X X 5 419 9 D corporation Name XX MICHAEL C• MCLAUGHLIN, LLC Address une 1 X X P. 0• BOX 7 9 0 Address lane 2 X X city XX HARRISBURG state X X P A aP XX 171D8 STEP D w Tax t.labillly & P-'d11et'd C. Restrkeed from Tex Report Psymenls +` Cradles Cakdatlon: A Minus B mkws C STEP E: Payment Make check far mk tmount ' Cradles on Dapoak PeyeDle to 7A DDpt of nsrenue CS/FF D D D D D LOANS D D D D D CNI D 0 D D D TOTAL D D D D D N Made Payment Via EFT STEP F: Refund (Transfer Method Choose one of the following options: A A =Total transfer of credk B =Total refund of credit STEP G: Corporate Officer (Sggn affirmation below) NAME PHONE FORM E-MAIL BARCODE I affirm under pertalYss presa'bed by law this report (ittcktdinp arty accompartyirrp edredula and sta[ernerNs) ha been examined by me and to the best of my knowledge and belief k a true. correct and compk~te repoR If Prepared by a P~ other than the taxpayer, hk deGaration b bead on all inbrrrratkxr of whk:h he ha a knowled e. Corporate Officer SignatenslDate 9Y46232.00o USE WHOLE DOLLARS ONLY 1010009215 ACCOUNT ID 5880424 Tax YEAR END 12312009 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 2 OF 6 PA CORPORATE TAX REPORT 2009 SECTION A: GSIFF OLDEST PERIOD TAX PERIOD TAX PERIOD FIRST BEGINNING ENDING YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 YEAR 6 YEAR 7 CUR YR 01012005 01012006 010120D7 01012008 01012009 12312009 12312006 12312006 1231200? 12312008 BOOK INCOME 4811 101 477 -9005 0 0 0 21034 Investment in LLC X X N Holding Comparry X X N Family Farm X X N WHOLE DOLLARS ONLY 2. TOTAL BOOK INCOME (sum of income for all tax periods up to, but not over 5 years total) 2 17 418 3. DIVISOR (in years and in part years rounded tD three decimal places) See InsUuciions. 3 5 • D DO 4. Divide Line 2 by Line 3. 4 3 4 8 4 5. AVERAGE BOOK INCOIAE -Enter Line 4, or if Line 4 is bss than mro enter "0". 5 3 4 8 4 8. Divide Line 5 by 0.095. 6 3 6 6 7 4 7. Shareholders' equity at the END of the current period ? 213 0 3 8. Shareholders' equtty at the BEGINNING of the current period 8 2 6 9 9. If Line 7 is more than twice as great or less than half as much as Line 8, add 9 10 7 8 6 Lines T and 8 and divide by 2. Otherwise enter Line 7. 10. NET WORTH -Enter Line 9, or H Line 9 is less than taro enter'0". 1 D 10 7 8 6 11. Multiply Line 10 by 0.75. 11 8090 t 2. Add Lines 6 and 11. 12 4 4 7 6 4 13. Divide Line 12 by 2. 13 2 2 3 8 2 14. S 150,000 valuation deduction 14 -15 D OO D 15. CAPITAL STOCK VALUE -Line 13 less Line 14, but not less than "0". If 100% taxable, 15 D enter Line 15 on Line 17. 16. Proportion of taxable assets or apportionment proportion (from Schedule 1+r1, Line 5) 16 0 17. TAXABLE VALUE -Multiply Line 15 by Line 16. If less than zero, enter'0". 17 D 18. CAPITAL STOCK/FOREIGN FRANCHISE TAX • MuWply Line 17 by 0.00269. 18 D Total Beginning of Taxable Year Assets 2 6 9 Total End of Taxable Year Assets 213 0 3 1010009215 9v,eeaz.~ 1010009215 1010009315 ACCOUNT ID 5880424 TAX YEAR END 12312009 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 3 OF 6 PA CORPORATE TAX REPORT 2009 SECTION B: Bonu~a Dopreciatdon Business Trust X X N 1. Currant year fad. deprea of 188k prop. 1 0 Solicitation Ony X X N 2. Current year adj. for disp. of 186k prop. 2 0 Single-Member LLC X X Y 3. Other adjustmer~ 3 0 MufthMember LLC X X N (Attach schedule C-3 if daiming PA-S Corporations X X N bonus depredation.) Taxable Built-ln Gains X X N SECTION C: CORPORATE NET WCOME TAX 1. Income or loss from federal return on a separate company basis 1 0 2. DEDUCTIONS: A. Corporate dividends received (From Schedub C-2, Line 6) 2 A 0 B. Interest an U.S. securities (GROSS INT less EXPENSES) 2 B 0 G Curr yr. addtl. PA daprec. plus adjust far sale (attached Schedule C-3) 2 C 0 D. Other (attached schedule) See instructions. 2 D 0 TOTAL D1D]UCTIONS -Sum of (A) through (D) 2 0 3. ADDTIONS: A. Taxes imposed on or measured by net income (attached schedule) 3 A 0 B. Tax Preference Items (attad,ed copy of Federal Form 4826) 3 B 0 G Empbyment incentive payment credit adjustment (attached Schedule W) 3 C 0 D. Current year bonus depreciation (attached Schedule C-3) 3 D D E Other (attached schedule) See instructions. 3 E 0 TOTAL ADDITIONS -Sum of (A) through (E) 3 0 4. Income or loss with Pennsylvania adjustments (Line 1 -Line 2 + L'me 3) 4 0 !i. Total nonbusiness income ar loss 5 0 6. Income or loss to be apportioned (Line 4 - Lina 5) 6 0 7. Apportionment proportion (from Schedule C-1 Line 5) 7 0 8. Income or loss apportioned to PA (Line 8 x Line 7) 8 0 9. Nonbusiness income or loss allocated to PA 9 0 10. Taxable income or loss after apportionment (Line 8 + Line 9) 10 0 11. Total net operating loss dedud3on (from RCT-103) 11 0 12. PA taxable income or bss (Line 10 -Line 11) 12 0 1 S. Corporate net income tax (Line 12 x 0.0999) 13 0 1010009315 er4eesz.ooo 1010009315 J USE WHOLE DOLLARS ONLY 1010009415 accouNT zD 5880424 TAX YEAR END 12312009 NAME MICHAEL C- MCLAUGHLIN, LLC RCT-101 PAGE 4 OF 6 PA CORPORATE TAX REPORT 2009 SECTION D: LOANS TAX 1. Did this corporation have a fiscal officer resident in PA and paying interest on indebtedness of the corporation? X X 2. Did this corporation have indebtedness outstanding to individual residents and/or perlrrerahips resident in Pennsylvania? X X 3. Did this corporation have Indebtedness outstanding held by a trustee, agent or guardian for a resident indvidual X X taxable in its own right or by an executor or administrator of an estate wherein the decedent was a resident of Pennsylvania? N N N List outshnding krdsbtsdness. Attach separate schedule if additional space is required. Inbrpt Amount Intrrngt Rabrt TarrabN Valurt p 0 0 Tax indetrt X X 0 0 0 0 0 0 D Loans Tax X X 0 SCHEDULE /41: Apportionment Schedule For Capital Stock/Forelgn Franchhe Tax (Include Form RCT 102, RCT-105 or RCT-106.) Three pia Single Factor Property-PA 1 A Q 1 C Q Numerator 4 A PropeAy-Total 1 B D Denominator 4 B payrgl-pA 2 A 0 2 C 0 Payrdl-?slat 2 B 0 ~-pq 3 A 0 3 C O Apportionment 5 sales-Total 3 B 0 Proportion SCHEDULE C-1: Apportionment Schedule For Corporate Net income Tax (Include Form RCT-106.) Three Fsctor Single Factor Property-PA 1 A 0 1 C 0 Numerator 4 A Property-Total 1 B 0 Denominator 4 B Payroll-PA 2 A 0 2 C 0 Payrdl-Total 2 B D sales-PA 3 A 0 3 C 0 Apportionment 5 sales-Total 3 B D Prom 0 a 0 0 0 0 L 1010009415 9V4ez62oao 1010009415 J 1010009515 ACCOUNT ID 5880424 Tax YEAR END 12312009 NAME MICHAEL C. MCLAUGHLiN, LLC RCT-101 PAGE 5 OF 6 PA CORPORATE TAX REPORT 2009 SECTION E: CORPORATE STATUS CHANGES Out of Existence/ Out of Eoddence X X N Withdrawal Date X X (Final Report) Date of Distribution of X X PA Assets' PA Corporations: Report data business activty ceased and date seeds were distributed. Foreign (Non-PA) Corporations: Report date business activity in PA ceased and date PA seeds were distributed. 'Schedule of Disposition of Assds MUST be completed and filed with the PA Corporate Taos Report Has the corporation sold or transferred in bulk 5196 or more of arty of the fdbwing lasses of seeds? Any stock of goods, wares, merchandise of any kind, fudures, machinery, equipment, buildkps or real estate. If so, please provide the name and address of the purchaser. (Attach separate schedub ff additional space is required.) Purdtaser Name X X Address Line 1 X X Address Line 2 X X city X X state X X ZIp X X ~ No Assets to Distribute XX N XX N SECTION F: GENERAL INFORMATION QUESTIONNAIRE Brief description of corporate activity in PA PUBLIC SERVICE / L 0 B B Y I N G SERVICE S Brief description of corporate actvity N / A outside PA List other states in which taxpayer has activity State of Incorporation X X P A Incorporatbn Date X X O L 012 0 0 3 1. Does any corporation, individual or other business entity held all ar a majority of the stock of this corporation? X X Y 2. Does this corporation own all or a majority of dock in other corporations? H yes, complete schedule x. X X N 3. Is this taxpayer a partnership that elects to fde federal taoaes as a corporation? X X N 4. Has the federal government changed taxable income as originally reported for any prior period for which reports of change X X N have not been filed in PA? N yes: First Period Food Date: X X Last Period End Datie: X X Accounting Method -Federal Tax Rdum C A=Accrual Gash 0=0Uoer Other Accounting Method -Financial Statements C A=Accrual C=Cash O~Uoer 1010009515 9V46B32.oo0 1010009515 1010009615 ACCOUNT ID 5860424 TAX YEAR END 12312D09 NAME MICHAEL C. MCLAUG HLIN, LLC RCT-101 PAGE 6 OF 6 PA CORPORATE TAX REPORT 2009 SCHEDULE OF REAL PROPERTY IN PA (Attach separate schedule if additanal space is requFed.) O=Own R@ Rant Stnat Address Cky County KOZlKOEZ XX 0 6135 WESTOVER DRIVE MECHANICSBURG CUMBERLAND N XX XX XX I~ORPORATE OFFlCERS SSN Last Nama First Nama M 1 PresidenUManaging Partner X X 17 8 3 810 2 6 MCLAUGHLIN MICHAEL C Vice President X X Secretary X X Treasurer/Tax Manager X X TAX PREPARER'S NAME AND ADDRESS Mall to Practitioner X X Y FederalElN XX 25-1644159 Firm Name XX BROWN SCHULTZ SHERIDAN FRITZ Addressunel XX 210 GRANDVIEW AVENUE Address une 2 X X city XX CAMP HILL state X X P A z1P XX 17011 Taz Pnpanr's Slgnature/Dab NAME JOHN P. WEID MAN PHONE E-MAIL 1010009615 1010009615 J 9Y48e6 3.000 pennsytvania REV-880 CT (OS-09) orr~rrort oc ~tve~ Schedule L -Balance Sheets for Single-Member Limi6ed Liability Companies when the Income is Reported on the Personal Income Tax Reim of the Member 1. Net income (loss) per books , , , , , , , , , , 2. Income included on federal Schedule C, federal Schedule E or federal Schedule F and not included on books this year (Nemize) , , , 3. Expenses recorded on books not included on federal Schedule C, federal Schedule E ~ federal Schedule F this year (demure) , , , , , a. Depreciation $ Beeinnina of Year End of Year a b c d Income included on books not included on federal Schedule C, federal Schedule E or federal Schedule F this year (item¢e) , , , Tax~xempt Interest $ Expenses recorded on federal Schedule C, federal Schedule E or federal Schedule F and not included on books this year (item¢e) , , , Oepreciatfon $ b. Travel and entertainment $ 670. Add Lines 5 and 6 , , , , , , , , , , , Income or Loss on federal Schedule C, federal Schedule E or federal Schedule F. 4. Add Lines 1 through 3 ............. Line 4 less Line 7 , , , , , , , , , , , , , , , 70 5s7. Schedule M-2 -Reconciliation of IEilember's Capital Account 1. Member's beginning capital account .............................. . 2. Capital contributed during tax period .............................. . 3. Net income for tax period .................................... . 4. Withdrawals of capital during tax period ............................ . 5. Member's ending capital account (Lines 1+2+3-4) Must equal Schedule L, Column D, Line 20 ........................... . 9Y4821 1.000 269. 69 57. 48 923. 21 303. 26715H K371 V09-8.4 Schedule M-1 - Reoondiation of income (Loss) per l3ooks to Income (Loss) per Retum REV 981 CT (09-09) cor~oRAnoN MICHAEL C . MCLAUGHLIN M M D D Y Y ACCOUNT ID 5880424 Tp,~jD ~ R 123109 SCHEDULE A-3 ADJUSTMENTS TO NET INCOME PER BOOKS (See instruction booklet for requirernerrts to complete this schedule) PART A 1. Net Inrromme per Books from Federal Sd~edule M-1 or Federal Sdredufe M-3. Additiorra 2. Dividends from subsidiary corporations not inducted in line 1. 3. Losses from subsidiary corporations deducted in aniving at Line 1 4. Losses from Limited Liability Companies deducxed in arriving at Line 1" 5. DisMbutions from Limited Liabilty Companies not inducted in Line 1" 6. Other (Itemize) 7. Total Lines 1 to 8 69,957 69,957 Reductior~ 8. Income from subsidiary corporations included in Line 1. 9. Income from Limited Liability Companies inducted in Line 1" 10. Distributions to Materially Partidpating Member of Lim'ded Liability Companies"" 4 8, 9 2 3 11.Other {ftemi~) 12. Total Lim 8 to 11 13. Revised Net Income per Books (Line 7 minus Line 12) 48,923 21,034 " Taxpayer's making these ac~ustments must provide a copy of Federal Schedule K-1, ff the investee LLC files Federal Form 1065, or, a reoondliation of beginning and ending net worth of the investee LLC ff the investee LLC is a disregarded entity. ""This reduction is only allowed to be taken by Limited Liability Companies and Business Trusts not taxed as corporations for Federal income tax purposes. Taxpayers claiming this reduction must complete Part B below. PART B Name of Member MICHAEL C . MCLAUGHLIN SSN or EIN of Member 178-38-1026 How does member quaky as materially partictpating under IRC Section 469 THE MANAGING SOLE MENIDER OF THE LLC Currerrt Year Distribution Less Current Year Distribution inducted in Prior Year Reduction Plus Current Year Reduction distributed in subsequent year 48,923 Current Year Reduction 48 , 923 Name of Member Current Year Distr~ution SSN or EIN of Member Less CuneM Year Distribufron inducted in Prior Year Reduction How does member quaky as materialy partidpating under IRC Section 489 Plus Current Year Reduction distributed in subsequent year Current Year Reduction Name of Member Current Y~r Distribution SSN or EIN of Member Less Current Year Distribution included in Prior Year Reduction How does member quaky as materially partidpating under 1RC Section 489 Plus Current Year Reduction distributed in subsequent year Current Year Reduction Total Reduction from Supplemental Sdredule (attach supplemental schedules ff necessary) ....................... . Total Reduction for Dishibutions to Materialy Partidpating Members {carry to Part A -Line 10) .................... . D9D3114916 PA-40 Schedule C - 2009 (09-09) Profit or Loss From Business or Profession (Sole Proprietorship) 178381026 MICHAEL C MCLAUGHLIN PUBLIC AFFAIRS 810588003 MICHAEL C• MCLAUGHLIN LLC Method of Inventory: CrCost, L~Lower of cost of market, O~other Accounting Method: A~Accrual, C~a:h, O~Itrer C Home ofRca expenses deducted 5 419 9 0 tusiness out of axisterka Any change in detarminbg N quaninies, or v~rrations 1 a. Gross raceipta or sales 1 A 8 9 6 8 0 2. cost of goods sdd/operations 2 0 1 b. Returns and elbwanees 1 B 0 3• Grow Profit 3 8 9 6 8 D 1 c. eela„ce 1 C 8 9 6$ 0 4. ottrer income (wbmtt statement) 4 0 5. Total Income 5 8 9 6 8 0 6. Advertising 6 0 28. Suppses (not inrduded on SeMdla C-1) 2 8 0 7. Amortizetkx, 7 p 2g. Tams 2 9 D 8. Bad debts from sales or servlam 8 0 30. Telephone 3 D D g. Bank charge: 9 p 31. Travel and anMrtatrsrrent 31 13 3 9 10. Car and truck expanses 1 D 3 3 9 4 3z. utllldas 3 2 0 11. comn,i:ebns 11 0 33. wages 3 3 0 12. Coat dapiegon not 96 depbtion 12 0 34. Other expanses (apaelfy): 13a.Regular depreciation 13 A 2 7 01 13bSection 179 expense ], 3 g 0 A SEE STATEMENT 1 A 14. Dues and publkations 14 0 B B 15. Ottxir empbyea perra8t programs ]r 5 0 C C 18. Freight (not an Schedule G1) 16 0 D D 1~.~nsurance 17 0 E E 18. Irneresl on buainesa indebNdness 18 0 F F G G H H 19. Laundry and rdeerrirrg 19 D I I zo. Legai and P serviees 2 0 212 3 J J 21. Management kes 21 0 K K 22. office wpplies 2 2 0 23. Pension and prolR sharing Plans 2 3 0 24. Postage 2 4 0 34. Total ottrer expentas 3 4 1016 6 z 5. Renton business property 2 5 D 35. Total expenses 3 5 19 7 2 3 z8. Repairs 2 6 0 38. Reduce expensae by total business credits 3 6 0 27. Subcontractor fees 2 '~ 0 37. Total ad)usted expanses 3 7 19 7 2 3 38. Net profit or bas 3 8 6 9 9 5 7 0903114916 Page 1 of 2 D9D3114916 9Y4849 9.1100 0903214922 J PA-40 Schedule C - 2009 nodal Security Number 17 8 3 810 2 6 Name of owner MICHAEL C MCLAUGHLIN SCHEDULE C-1 -Cost of Goods Sold andltx Operations 1. Inventory at beginning of year (If different from last year's dosing inventory, indude euq>fanation) 2a. Purchases 2b. Cost of kerns withdrawn for personal use 2c. Balance (subtract Lino 2b from Line 2a) 3. Cost of labor (do not indude salary paid to yourself or subcontractor fees) 4. Materials and supplies 5. Other costs (include schedule) 8. Add L'mes 1, 2c, 3, 4 and 5 7. Inventory at end of year S. Cost of goods sdd andlor operations (subtract Line 7 from Line 8) Enter here and on Part I, L'me 2 SCHEDULE C-2 -Depreciation (Sae instructions) 1. Total Section 179 depredation (do not include In Items below) 2. Less: Section 179 depreciation included in Schedule C-1 3. Balance (subtract Line 2 frorrr Line 1). Enter here and on Part II, Line 13b 4. Other depreciation: Deseription of property Date aoquirad Cost or other t>esfs Deprechtlon allowed ar MNhod of compusns (a) Ip) lo) elbwable in prbryaars dapredratlm (d) (e) e~,Nar~ 4 A Pumuun /fi~0urw 4 B Trans. wu~t 4 C Mschlnery 4 D oln. (aD~ri 4E 4F 4G 4H 4I 4J 4K 4L 4M 4N 40 4P 5. Totals 8. Depredation included in Schedule G1 7. Balance (subtract Line 8 from Line 5) Enter here and on Part II, Line 13a Page2o~f2 0 9 0 3 214 9 2 2 araea z.ooo 1 0 2A 0 26 0 2C 0 3 0 4 D 5 0 6 0 7 D 8 0 1 D 2 0 3 0 Life or rate Depreciation for ~fl thb !~ lo) DEPRECIATION 5 2701 6 0 ? 2701 0903214922 .J MICHAEL C MCLAUGHLIN 178-38-1026 SUPPLEMENT TO PENNSYLVANIA SCHEDULE C BUSINESS NAME - MICHAEL C. MCLAUGHLIN LLC OTHER EXPENSES -------------------------------------------------------- OFFICE-IN-HOME EXPENSES BUSINESS EXPENSES INTERNET SERVICE BANK FEES SALES TAXES TOTAL OTHER EXPENSES TO SCHEDULE C, LINE 32A AMOUNT 4,141. 1,724. 1, 105. 134. 3,062. 10, 166. STATEMENT 1 4OY1WH K371 V09-8 JPW-25548 1p10010120 _ A CORPORATE TOAX REPORT 2 0 1 0 DEPARTMFJd'f' USE ONLY G A = 1120 B = 1120S C = 11200 D = 1120E E = 1120H F = 1065 G = 1040 H =Other STEP A STEP B Tax Year Beginning X X 01 D b 2 010 Regulated Inv. Co. X X N First Report X X N Tax Year Ending X X 1231201 D 52-53 Week Filer X X N KOZ/EIP/SDA CrediE X X N Address Change X X Y File Period Change X X N Change Fed Group X X N STEP C Corp Tax Account ID X X 5 8 8 0 4 2 4 Federal EIN X X 81588003 Business Activity Code X X 5 419 9 0 Corporation Name XX MICHAEL C• MCLAUGHLIN~ LLC Address Line 1 X X 2 b 8 E• G O W E N A V E• Address Line 2 X X city XX PHILADELPHIA state X X P A ZIP X X 19119 -USE WHOLE DOLLARS ONLY STEP D A Tax liability B. Estimated C. Restricted P°~°~ ~` Calculation; STEP E: Payment Make check for this amount from Tax Report Credits Credits on Deposit Amines B minus C Dayable to'PA Dapt Of Revenue' CS/FF D D 0 0 D LOANS 0 0 0 0 0 CNI 0 0 0 0 0 TOTAL D 0 D 0 0 N Made payment electronically STEP F: Transfer/Refund Method Choose one of the following options: B A =Transfer available credit B =Refund available credit STEP G: Corporate Officer (Sign affirmation below) NAME PHONE FORM E-MAIL BARCODE 1 affirm under penalties prescribed by law this report (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is a ttue, correct and complete report. Corporate Officer SignaturelDate OY4623 1.000 1010010220 ACCOUNT ID TAX YEAR END RCT-101 PAGE 2 OF 6 SECTION A: CS/FF OLDEST PERIOD TAX PERK FIRST BEGINNING YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 YEAR 6 YEAR 7 CUR YR 01012006 01012007 01012DD8 01012009 5880424 12312010 NAME MICHAEL C• MCLAUGHLIN, LLC PA CORPORATE TAX REPORT 2010 TAX PERIOD ENDING BOOK INCOME 12312006 12312007 12312008 12312009 101 477 -9D05 21034 0 0 0 -21303 Investment in LLC X X Holding Company X X Famiy Farm X X N N N 01012010 06102010 USE WHOLE DOLLARS ONLY 2. TOTAL BOOK INCOME (sum of income for ell tax periods up to, but not over 5 years total) 2 - 8 6 9 6 3. DNISOR (in years and in part years rounded tD three deamal places) See instructions. 3 4 • 4 4 4 4. Divide Line 2 by Line 3. 4 -19 5? 5. AVERAGE BOOK INCOME -Enter Line 4, or ff Line 4 is less than zero enter '0". 5 D 8. Divide Line 5 by 0.095. 6 0 7. Shareholders' equity at the END of the curcent period 7 0 8. Shareholders' equity at the BEGINNING of the current period 8 213 0 3 9. If Line 7 is more than twice as great or less than half as much as Line 8, add 9 10 6 5 2 Lines 7 and 8 and divide by 2. Otherwise enter Line 7. 10. NET WORTH -Enter Line 9, or ff Line 9 is less than zero enter "0". 10 10 6 5 2 11. Multiply Line 10 by 0.75. 11 7 9 8 9 12. Add Lines 6 and 11. 12 7 9 8 9 13. Divide Line 12 by 2. 13 3 9 9 5 14. $160,000 valuation deduction 14 -16 0 0 0 0 15. CAPITAL STOCK VALUE -Line 13 less Line 14, but not less than "0". ff 100% taxable, 15 D enter Line 15 on Line 17. 18. Proportion of taxable assets or apportionment proportion (from Schedule A-1, Line 5) 16 0 17. TAXABLE VALUE -Multiply Line 15 by Line 16. If less than zero, enter "0". 17 0 18. CAPITAL STOCKIFOREIGN FRANCHISE TAX -Multiply Line 17 by 0.00289. 18 0 Total Beginning of Taxable Year Assets 213 0 3 Total End aF Taxable Year Assets D 1010010220 OY46sa2.oo0 1010010220 1D10010320 ACCOUNT ID 5880424 TAX YEAR END 1231201D NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 3 OF 6 PA CORPORATE TAX REPORT 2010 SECTION B: Bonus Depreciation Business Trust X X N 1. Current year fed. deprec. of 168k prop. 1 0 Solicitation Only X X N 2. Current year adj. for disp. of 168k prop. 2 D Single-Member LLC X X Y 3. Other adjustments 3 D Multi-Member LLC X X N (Attach schedule C-3 if chiming PA-S Corporations X X N bonus depreciation.) Taxable Buirt-in Gains X X N SECTION C: CORPORATE NET INCOME TAX 1. Income or loss from federal return on a separate company basis USE WHOLE DOLLARS ONLY 1 2. DEDUCTIONS: D A. Corporate dividends received (from Schedule C-2, Line 6) 2 A 0 B. interestan U.S. securities (GROSS INTless EXPENSES) 2 B 0 C. Curr yr. addtl. PA depreC. plus adjust for sale (attached Schedule G3) 2 C 0 D. Other (attached schedule) See instructions. 2 D 0 TOTAL DEDUCTIONS -Sum of A through D 2 D 3. ADDITIONS: A. Taxes imposed on or measured by net income (attached schedule) 3 A 0 B. Tax Preference Items (attached SPY of federal Forth 4626) 3 B D C. Employment incentive payment credit adjustment (attached Schedule W) 3 C D D. Current year bonus deprecation (attached Schedule C-3) 3 D 0 E Other (attached schedule) See instructions. 3 E 0 TOTAL ADDITIONS -Sum of A through E 3 0 4. income or loss with Pennsylvania hdjustments (Line 1 -Line 2 + Line 3) 4 D 5. Total nonbusiness income or loss 5 D 6. income or loss to be apportioned (Line 4 -Line 5) 6 0 7. Apportionment proportion (from Schedule C-1 Line 5) 7 D 8. Income or loss apportioned to PA (Line 6 x Line 7) 8 D 9. Nonbusiness income or loss allocated to PA 9 D 10. Taxable income or loss after apportionment (Line 8 + Line 9) 10 0 11. Total net operating loss deduction (from RCT 103) 11 0 12. PA taxable income or loss (Line 10 -Line 11) 12 0 13. Corporate net income tax (Line 12 x 0.0899) 13 ^ 1010010320 orasss~.ooo 1010010320 J 1010010420 accouNT ID 58aD42+~ TAX YEAR END 12312010 NAME MICHAEL C. MCLAUGHLIN, LLC RCT-101 PAGE 4 OF 6 PA CORPORATE TAX REPORT 2010 SECTfON D: LOANS TAX 1. Foreign Corporations Only. Did this corporation have a fiscal officer resident in Pennsylvania? X X 2. Did this corporation have indebtedness outstanding to individual residents and/or partnerships resdent in Pennsylvania? X X 3. Did this corporation have indebtedness outstanding held by a trustee, agent ~ guardian for a resident individual X X taxable in its own right or by an executor or administrator of an estate wherein the deceder-t was a resident of Pennsyhra[-ia? Llst outstanding indebtedness. Attach separate schedule tf additional space is required. Interest Amount Interest lisle Taxable Value Taxable 0 0 0 indebtedness X X 0 0 0 0 0 0 Loans Tax X X SCHEDULE A~1: Apportionment Schedule For Capital StockfForeign Franchise Tax (Include Form RCT-102, RCT-105 or RCT 106.) Three Factor Single Factor property_pq 1 A 0 1 C 0 Numerator 4 A Property-Tai 1 B 0 Denominator 4 B Payroll-PA 2 A ^ 2C 0 Payrofi-Total 2 B 0 ~~..pq 3 A Q 3C 0 Apportionment 5 Sales-Total 3 B 0 Proportion SCHEDULE C-1: Apportionment Schedule For Corporate Net Income Tax (Include Form RCT 106.) Three Factor Single Factor Property-PA 1 A 0 1 C 0 Numerator 4 a Property-Total 1 6 0 Denominator 4 B Payroll-PA 2 A 0 2C 0 Payroll-Total 2 B 0 Sales-PA 3 A 0 3C 0 Apportionment 5 Sales-Total 3 B 0 Proportion N N N 0 D D 0 0 0 0 0 1010 01 D 4 2 0 ovasze ~.oo0 1010 01 D 4 2 0 J 1010010520 ACCOUNT ID 5880424 TAX YEAR END 12312010 NAME MICHAEL C • MCLAUGHLIN, LLC RCT-101 PAGE 5 OF 6 PA CORPORATE TAX REPORT 2010 SECTION E: CORPORATE STATUS CHANGES Out of Existenr~J out of Existence X X Y w ithdrawai Date X X 0 610 2 010 (Final Report) Date of Distribution of X X Q$ No Assets X X Y PA Assets' to Distribute PA Corporations: Report date business actively ceased and date assets were distributed. Foreign (Non-PA) Corporations: Report date business activity in PA used and date PA assets were distributed. 'Schedule of Disposition of Assets MUST be completed and filed with the PA Corporate Tax Report. Has the corporation sold or transferred in bulk 5i percent or more of any of the fdiowing classes of assets? X X N Any stock of goods, wares, merchandise of any kind, fixtures, machinery, equipment, buildings or real estate. If so, please provide the name and address of the purchaser. (Attach separate schedule if addtdonal space is required J Purchaser Name X X Address Line 1 X X Address Line 2 X X City X X State X X zlp X X SECTION F: GENERAL INFORMATION QUESTIONNAIRE Describe corporateacGvityinPA PUBLIC SERVICE/LOBBYING SERVICES Describe corporate activity outside PA N / A Other states in which taxpayer has activity State of Incorporation X X P A incorporation Date X X 01012 0 0 3 1. Dces any corporation, individual or other business entity hold aIF or a majority of the stock of this corporation? X X Y 2. Dces this corporation own all or a majority of stock in other corporatlons? tf yes, car-plete Schedule X. X X N 3. Is this taxpayer a partnership that elects to file federal taxes as a corporation? X X N 4. Has the federal government changed taxable Income as originally reported for any prior period for which reports of change X X N have not been fNed in PA? if yes: First Period End Date: X X Last Period End Date: X X Accounting Method -Federal Tax Return C A=Accrual C=Cash O=Other Other Accounting Method -Financial Statements C A=Accrual C=Cash O=Other Other L. 1010010520 OY46634.000 1010010520 J 101D01D620 ACCOUNT ID 5880424 TAX YEAR END 12312010 NAME MICHAEL C• MCLAUGHLIN, LLC RCT-101 PAGE 6 OF 6 PA CORPORATE TAX REPORT 2010 SCHEDULE OF REAL PROPERTY IN PA (Attach separate schedule 'If addiflonal space is requ~ed.) O =Own R= Rsrrt Strest Address City County XX 0 6135 WES TOVER DRIVE MECHANICSBURG CUMBERLAND XX XX XX CORPORATE OFFICERS SSN Last Name First Name (Sse Instructions) PresidenUManagingPartner XX 178381026 MCLAUGHLIN MICHAEL vice President X X Secretary X X TreasurerJTax Manager X X TAX PREPARER'S NAME AND ADDRESS Mail to Practitioner X X Y Federal E1N or SSN X X 2 5 -16 4 415 9 Firm Name XX BROWN SCHULTZ SHERIDAN FRITZ AddressLinel XX 210 GRANDVIEW AVENUE Address Line 2 X X city XX CAMP HILL State X X P A ZIP X X 17 011 KOZlKOEZ N MI C I affirm under penalties prescribed by law, this report (Including any accomparrying schedules and statements) has been prepared by me and to the best of my knowledge and belief Is a hue, correct complete report. Tax Preparer's SignaturelDete NAVE JOHN P• WEIDMAN PHONE E-MAIL FEDERAL P00225707 PTIN '„~ 1D10D1D620 oraese,.ooo 101001062D J REV-860 C'r (07-10) Pennsylvania OEPARTYENT OF REVBIUE Schedule L'-Balance Sheets for Single-Member.Limited Liability +Companies when #he;income is Reported on the Personal Income;Tax Return of the Member Begnning of Year End of Year a b c d 1. Cash ai 3oa. 2.a. Trade notes and accounts receivable b. Less allowance for bad debts 3. Inventories - 4. U.S. overnment obi' ations ~ ; ;r , 5. Tax-exam t securities :-s `' . ,~.~ 6. Other current assets attach schedule ri:=~ a 7. Mort a e and real estate bans -" ^~`: •~k . :~ _ ,~ 8. Other investments attach schedule - 9.a. Buiklin sand other de recisble assets 2 eo3. b. Less accumulated de eciation a eo3. 10.a De letable assets ~ -_ b. Less accumulated d lion 11. Land net of an amort¢atan 12.a. Intan ible assets amort¢able on i z o o . ~. b. Less accumulated amortization i zoo. 13. Other assets attach schedule `~:~' + ~ :`1 £ r~-~ 14. Total assets °~, ~4~n=,~ ai 303, 4'-.y"~`" ,_, t.. Liabilities and ca ital ..~~ <~,%~_ - ~~ ;,~~• ' . =_ k - 15. Accounts a able ~ -~~^`=~~~~ ,ac,_'#,'~'- ' 16. Mort a es notes, bons a ble ~ less than one ear '' ` `its = X64'-- ~' ~" - 17. Other current liabilities attach schedule ~~' ~3~r .'~•~'! ' -~ v t =`:_: 18. Mort a es, notes, bonds a able in one ear or more s~ `•-~:'` '_ t`~a '~:`; 19. Other liabilities attach schedule y; _~ ,~~ r 20. Member's Ca ital account ''"~'` ! <}•_'' ai 303. '~~ z~ "`c 21. Total liabilities and ca ital ~r_' ai 303. "' ~` Schedule M-1-Reconciliation of income {Loss] per Books to lncame {Loss] per Return Income included on books not included on 1. Net income (foss) per books, , , , , , , , , , federal Schedule C, federal Schedule E or 2. Income included on federal Schedule C, federal Schedule F this year (itemize) . , , federal Schedule E or federal Schedule F and Tax-exempt interest $ not included on books this year (itemze) , , , 3. Expenses recorded on books not included on federal Schedule C, federal Schedule E or federal Schedule F this year (itemze) , , , , , a Depreciation $ Expenses recorded on federal Schedule C, federal Schedule E or federal Schedule F and not included on books this year (itemize) , , , Depreciation $ b. Travel and entertainment $ so. Add Lines 5 and 6 , , , , , , , , , , , , , Income or Loss on federal Schedule C, federal Schedule E or federal Schedule F. 4. Add Lines 1 through 3 ............. Line 4 less Line 7 , , , , , , , , , , , , 46 915. Schedule M-`2 -Reconciiiatinn ofi`Member's Capital Account 1. Member's beginning capital account ............................... 21 303 . 2. Capital contributed during tax period ......... ............. ........ . 3. Net income for tax period ..................................... 4 6 855 . 4. Withdrawals of capital during tax period ............................. 6 8 15 8 . 5. Member's ending capital account (Lines 1+2+3-4} Must equal Schedule L, Column D, Line 20 ................ . . .......... . 0Y4821 1.000 26715H K371 V10-4.4 REV-961 CT (07-10) M M D D Y Y CORPORATION NAME rncxaEL c. rtCr~UCFta,irr, LLC a ccoin=D 5880424 ENDINGR 123110 SCHEDULE A-3 AD]USTMENTS TO NET INCOME PER BOOKS (See CT 1 booklet at www.revenue.state.pa.us for requirements to complete this schedule) PART A 1. Net Income per Books from federal Schedule M-1 or federal Schedule M-3. 4 6, 8 5 5 Additions 2. Dividends from subsidiary corporations not included in Line 1 3. Losses from subsidiary corporations deducted in arriving at Line 1 4. Losses from Limited Liability Companies deducted in arriving at Line 1* 5. Distributions from Limited Liability Companies not included in Line i* 6. Other (Itemize) 7. Total Lines 1 to 6 46,855 Reductions 8. Income from subsidiary corporations included in Line 1 9. Income from Limited Liability Companies induded in Line 1* 10. Distributions to Materially Partidpating Member of Limited Liability Companies** ii.Other (Itemize) 12. Total Lines 8 to 11 13. Revised Net Income per Books (Line 7 minus Line 12) 68.158 68,158 (21,303) * Any taxpayer making these adjustments must provide a copy of federal Schedule K-1, if the investee LLC files federal Form 1065, or a reconciliation of beginning and ending net worth of the investee LLC, if the investee LLC is a disregarded entity. ** This reduction may only be taken by Limited Liability Companies and Business Trusts not taxed as corporations for federal income tax purposes. Taxpayers claiming this reduction must complete Part B below. PART B Name of Member MICHAEL C . MCLAUGHLIN SSN or EIN of Member 17 8 - 3 8 -10 2 6 How does member qualify as materially participating under IRC Section 469? THE MANAGING MEMBER OF THE SINGLE MEMBER LLC Current Year Distribution 6 8 ,15 8 Less Current Year Distribution induded in Prior Year Reduction Pius Current Year Reduction distributed in subsequent year Current Year Reduction 6 8 ,15 8 Name of Member Current Year Distribution SSN or EIN of Member Less Current Year Distribution included in Prior Year Reduction How does member qualify as materially participating under IRC Section 469? Plus Current Year Reduction distributed in subsequent year Current Year Reduction Name of Member Current Year Distribution SSN or EIN of Member Less Current Year Distribution included in Prior Year Reduction How does member qualify as materially participating under IRC Section 469? Plus Current Year Reduction distributed in subsequent year Current Year Reduction Total Reduction from Supplemental Schedule (Attach additional schedule(s) if necessary) ..................... . Total Reduction for Distributions to Materially Partidpating Members (carry to Part A -Line 10) ................. . 1003117841 PA-40 Schedule C • 2010 (OS-10) Profit or Loss From Business or Profession (Sole Proprietorship) 17838102b MICHAEL C MCLAUGHLIN PUBLIC AFFAIRS 810588003 MICHAEL C• MCLAUGHLIN LLC Method of Inventory: C=~OSt, L=Lower of cost or market, Other Accounting Method: A=Accrual, Gash, OsOUrer ~ Home office expenses deducted 5 419 9 D Business out of e~astence Any change M determining N quantities, costs orvaiuatxxis 1 a. cross receipts or sales 1 A 5 4 816 2. Cost of goods soid/operatbns 2 D 1 b. Returns and ~krNencres 1 B D s. ~'°~ pry 3 5 4 816 1 c. Balance ]r ~ 5 4 816 4. Other incmne (submR statement) t} D 5. Total incxrme 5 5 4 816 6. Advertising 6 D 28. Supplies (not included on schedue C•1) 2 8 0 7. Amortization '~ D 29. Taxes 2 9 ^ 8. Bad debts from sales or sus 8 D 30. Telephone 3 D D 9. Bank charges 9 D 31. Travel end entertainment 31 4 7 7 1 l). Car and truck expenses 1 D D 32. Utilities 3 2 D 11. commissions 11 D 33. Wages 3 3 D 12. Cost depleton not % depletion 12 D 34. Other expenses (specify): 13a.Regulardeprecfafion 13 A 1463 13bSection 179 expense 13 B D A SEE STATEMENT 2 A 14. Dues and pubfications 14 D B B 15. Other employee benefit programs 15 D C C 18. Freight (not on Schedule C-1) ]r 6 D D ]) 17. insurance 17 566 E E 18. Interest on business indebtsdne6s 18 4 6 5 F F G G H H 19. Laundry and Leaning 19 D I I 20. Legal and professional services 2 D D J J 21. ManagemeMfe~ 21 D K K 22. Office supplies 2 2 D 23. Pension and Profit-sharing Plans 2 3 D 24. Postage 2 t{ D 34. Total other expenses 3 4 4 9 9 D 25. Renton business property 2 5 D 35. Total expenses 3 5 7 9 61 26. Repa&s 2 6 D 36. Reduce expenses by total business credits 3 6 0 27. Subcontractorfees 2 7 D 37. Toth adjusted expenses 3 7 7 9 6 1 38. Net profit or loss 3 8 416 8 5 5 L Page 1 of 2 J 10031178 41 10 0311?841 OY4643 2.000 1003217856 PA-40 Schedule C - 2010 Social Security Number 17 8 3 810 2 6 Name of owner MICHAEL C MCLAUGHLIN SCHEDULE C-1 -Cost of Goods Sold and/or Operations 1. tnventory at beginning of year (If different from last year's dosing Inventory, indude e~lanation) 1 0 2a. Purchases 2 A 0 2b. Cost of items withdrawn for personal use 2 B 0 2c. Balance (subtract Line 2b from Line 2a) 2 C 0 3. Cost of labor (do not indude salary paid to yourself or subcontractor fees) 3 0 4. Materials and supplies 4 0 5. Other costs (indude schedule) 5 D 8. Add Lines 1, 2c, 3, 4 and 5 6 0 7. Inventory at end of year 7 0 8. Cost of goods sold andlor operations (subtract Line 7 from Line 6) Enter here and on Part I, Line 2 8 0 SCHEDULE C 2 -Depreciation (See Instructions) 1. Total Section 179 depreciation (do not indude in ftems below) 1 0 2. Less: Section 179 depredation inducted in Schedule G1 2 D 3. Balance (subtract Line 2 from Line 1). Enter here and on Part tl, Line 13b 3 0 4. Other depredation: Description of property Date acquired Cost or other basis Depreciation allowed ar Metnod a canputlng allowable in pr~years deprecialim Life or rate Depreciation for this year (a) (b) (c) ids (e) ifl (9) euild'mB~ 4 A Fumfwre Mbures 4 B Trans. ~~rornenr 4 C Macnlnary 4 D om ar tapw~riri 4E 4F 4G 4H 4I 4J 4K 4L 4M 4N 40 4P 5. Totals DEPRECIATION 5 1463 6. Depreciation included in Sd~edule C-1 6 0 7. Balance (subtract Line 6 ftom Line 5) Enter here and on Part it, Line 13a 7 14 6 3 Page2of2 100 3217856 10032b7856 oraeaaz.ooo MICHAEL C MCLAUGHLIN 178-38-1026 SUPPLEMENT TO PENNSYLVANIA SCHEDULE C BUSINESS NAME - MICHAEL C. MCLAUGHLIN LLC OTHER EXPENSES AMOUNT ------------------------------------------------------------ ------------ OFFICE-IN-HOME EXPENSES BUSINESS EXPENSES INTERNET SERVICE BANK FEES TOTAL OTHER EXPENSES TO SCHEDULE C, LINE 32A 1,831. 2,460. 687. 12. 4, 990. STATEMENT 2 4OY1WH K371 V10-4.3 JPW-25548 MICHAEL C. MCLAUGHLIN, LLC PENNSYLVANIA LLC FOOTNOTES 810588003 ------------------------- MICHAEL C. MCLAUGHLIN, THE SINGLE MEMBER OF THE LLC, PASSED AWAY ON JUNE 10, 2010. THE REMAINING CASH BALANCE OF $2,847 WAS DISTRIBUTED TO HIS ESTATE. THERE WERE NO OTHER ASSETS 10 DISTRIBUTE. OXX063 1.000 STATEMENT 1 26715H K371 V10-4.4 MORTGAGE NOTE U.S. $12, 356.50 Dauphin County, Pennsylvania February 28, 2002 ao~a FOR VALUE RECEIVED, ROBERTA M. KLEIN of G ~ 3 ~ ~t'STu~6Q 7R• Pennsylvania (hereinafter called "Borrower"), promises to pay MICHAEL MCLAUGHLIN of m ~ ~ ~~ ~ 5 2 ~t 2 G- ,Pennsylvania, (hereinafter called "Lender") the principal sum of Twelve Thousand Three Hundred Fifty-Six and 50/100 ($12,356.50) DOLLARS, with interest on the unpaid principal balance from the date of this Note, until paid, at the rate of - O -percent per annum. Principal and interest shall be payable at Pennsylvania or such other place as the Note holder may designate. At the time of sale and settlement of the property lrnown as 4830 Brian Road, Mechanucsburg, Pennsylvania, the entire remaining principal balance, together with accrued interest and other sums, if any, due hereunder, shall be due and payable. 2. Prepayment. Borrower may prepay this Note in whole or in part at any time without penalty. 3. Secured Bv. The indebtedness evidenced by this Note is secured by a Mortgage dated February 28, 2002 for the Property, and reference is made to the Mortgage for rights as to acceleration of the indebtedness evidenced by this Note (the Note and Mortgage together called the "Loan Documents"). 4. Option to Pay Borrower's Obli ations. At its option (but after any required notice contained in the Mortgage), Lender may, for the account of Borrower, pay any tax, or installment thereof, assessment or water rent, or insurance premium or any sums which under the terms of the Mortgage the Borrower is obligated to pay or do, but fails so to do and the amount so paid shall be added to and become part of the principal sum payable hereunder and secured by the Mortgage and shall be payable on demand with interest. 5. Mortgage Default. If an "Event of Default" occurs under the Mortgage, then Lender, at its option and without further notice to Borrower, may declare immediately due and payable the entire unpaid balance or principal with interest accrued thereon and all other sums due by Borrower under the Loan Documents, anything in any of the Loan Documents to the contrary notwithstanding; and payment thereof may be enforced and recovered in whole or in part at any time by one or more of the remedies provided to Lender in the Loan Documents. 6. Costs and Expenses. In the event of default, Lender may also recover all costs of suit and other expenses in connection therewith, together with an attorney's commission for collection of Five percent (5%) of the total amount then due by Borrower to Lender, but in any event not less than Five Hundred ($500.00) Dollars, together with interest on any judgment obtained by Lender, through and including the date of any sheriff s sale. -1- 7. Confession of Judgment. (a) Borrower hereby irrevocably authorizes and empowers any attorney or the Prothonotary or Clerk of any court in the Commonwealth of Pennsylvania, or elsewhere, to appear at any time, or after default, for Borrower in any action brought against Borrower on this Note at the suit of Lender, with or without declaration filed, as of any term, and therein to confess or enter judgment against Borrower for the entire unpaid principal of this Note and all other sums paid by Lender to or on behalf of Borrower pursuant to the terms of the Loan Documents, attorney's commission of Five percent (5%) for collection, but in any event. not less than Five Hundred ($500.00) Dollars; and for so doing this Note or a copy hereof verified by affidavit shall be sufficient warrant. BORROWER ACKNOWLEDGES THAT IT UNDERSTANDS THE MEANING AND EFFECT OF THE CONFESSION CONTAINED IN THE FOREGOING PARAGRAPH. SPECIFICALLY, BORROWER UNDERSTANDS AMONG OTHER THINGS THAT (i) BORROWER IS RELINQUISHING THE RIGHT TO HAVE NOTICE, AN OPPORTUNITY TO BE HEARD AND THE RIGHT TO HAVE THE BURDEN OF PROOF OF DEFAULT REST ON THE HOLDER PRIOR TO THE ENTRY OF JUDGMENT, (ii) THE ENTRY OF JUDGMENT MAY RESULT IN A LIEN ON BORROWER'S PROPERTY, (iii) BORROWER WILL BEAR THE BURDEN AND EXPENSE OF ATTACKING THE JUDGMENT AND CHALLENGING EXECUTION ON THE LIEN AND SALE OF THE PROPERTY COVERED THEREBY, AND (iv) ENOUGH OF BORROWER'S PROPERTY MAY BE TAKEN TO PAY THE PRINCIPAL AMOUNT, INTEREST, COSTS AND ATTORNEYS' FEES OF LENDER (b) The authority granted herein to confess judgment shall not be exhausted by any exercise thereof but shall continue from time to time and at all times until payment in full of all the amounts due hereunder. 8. Release of Errors. Borrower hereby waives and releases all errors, defects and imperfections in any proceedings instituted by Lender under the terms of this Note, as well as all benefit that might accrue to Borrower by virtue of any present or future laws, including those exempting the mortgaged property or any other property, real or personal, or any part of the proceeds arising from any sale of any such property, from attachment, levy or sale under execution, or providing for any stay of execution, exemption from civil process, or extension of time for payment; and maker agrees that any real estate and/or personal property that may be levied upon pursuant to a judgment obtained by virtue hereof, on any writ of execution issued thereon, maybe sold upon any such writ in whole or in part in any order desired by Lender. 9. Waiver of Notice. Borrower and all endorsers, sureties and guarantors, hereby jointly and severally waive presentment for payment, demand, notice of demand, notice of non- payment or dishonor, protest and notice of protest of this Note, and all other notices in connection with the delivery, acceptance, performance, default or enforcement of the payment of this Note, and they agree that the liability of each of them shall be unconditional, without regard to the liability of any other party, and shall not be affected in any manner by an indulgence, extension of time, renewal, waiver or modification granted or consented to by Lender. Borrower and all endorsers, sureties and guarantors consent to any and all extensions of time, renewals, waivers, or modifications that may be granted by Lender with -2- respect to the payment or other provisions of this Note, and to the release of the collateral or any part thereof, with or without substitution, and agree that additional borrowers, endorsers, guarantors, or sureties may become parties hereto without notice to them or affecting their liability hereunder. 10. Forbearance. Lender shall not be deemed, by any act of omission or commission, to have waived any of its rights or remedies hereunder unless such waiver is in writing and signed by Lender, and then only to the extent specifically set forth in writing. A waiver on one event shall not be construed as continuing or as a bar to or waiver of any right or remedy to a subsequent event. 11. Remedies Cumulative. The remedies of Lender contained herein shall be cumulative and concurrent, and maybe pursued singly, successively or together at the sole discretion of Lender, and may be exercised as often as occasion therefor shall occur; and the failure to exercise any such right or remedy shall in no event be construed as a waiver or release thereof. 12. Joint and Several. If this Note is executed by more than one person as Borrower, the obligation, responsibility and liability of each such person shall be joint and several. 13. Notices. All notices or other communications pursuant hereto shall be in writing and shall be given when delivered personally or deposited in the United States mail, postage prepaid, return receipt requested, addressed to the parties set out below: If to Borrower: Roberta M. Klein (ol3S 4rfsTduF2 ~it• rnEcMAN+c53~2G.,~A• 17oSb If to Lender: Michael McLaug~jm (, i 3 S ~,.rC~~'uvGQ 1'~6r YY1 E c IbA~-+~c Sfl J 2 ~ , PP . 17 uS-Gi 14. Applicable Law. This instrument shall be governed by and construed according to the laws of the Commonwealth of Pennsylvania. 15. Gender. Whenever used, the singular number shall include the plural, the plural the singular, and the use of any gender shall be applicable to all genders, and words "Lender" and "Borrower" shall be deemed to include the respective heirs, personal representatives, successors and assigns of Lender and Borrower. 1N WITNESS WHEREOF, intending to be legally bound hereby, the Borrower has executed this Note on the day and year first above written. Signed, Sealed and Delivered in the presence of: ~~ oberta M. Kle' -3- .~-°`° ~ a~ ~~ August 31, 2010 Heather D. Royer, Esq. River Chase Office Center 3ra Floor 4431 North Front Street Harrisburg, PA 17110-1778 Dear Ms. Royer: pD IFS GROUP An Integrated Financial Services Company We are writing this letter in response to your request for account information for Michael McLaughlin, Deceased. Mr. McLaughlin held two accounts with our institution at the time of his death on June 10, 2010. One was an individual account (1226-1481); account opened on 1/17/06. This account was closed on June 29, 2010 at the request of the executor, Joseph McLaughlin. A third party check, in the amount of $479.86, was mailed to the executor for the benefit of the estate account already established. Date of death value on June 10, 2010 was $479.88 Second, Mr. McLaughlin had a SEP IRA (4655-4658); account opened on 1/4/06. This account was closed on 7/1/10 and transferred to a Beneficiary IRA account (5548-4835) in the name of his widow, Nicole McLaughlin. She was listed as the primary beneficiary on his account. Date of death value on June 10, 2010 was $11,035.20. We have enclosed the June 2010 statements for the two Michael McLaughlin accounts, as well as, the July 2010 Beneficiary IRA account for Nicole McLaughlin. Should you need any additional information from our firm please do not hesitate to contact me at 717- 766-1144 ext. 105. JEx/jff Enclosures Cc: file 1205 Manor Drive Suite 201 Mechanicsburg, PA 17055.4917 717.766.1144 877.392.2949 toll free 717.766.3361 fax Secudtles offered through LPL Financial Member FlNRA/SIPC PSE(~k July 22, 2010 Smigel, Anderson & Sacks, LLP Attorneys at Law River Chase Office Center, 3rd Fl 4431 North Front Street Harrisburg, PA 17110-1778 Atlas: Heather Royer Re: Michael C McLaughlin, Deceased. Account # 178381026 Dear Ms. Royer: ~- • 4 -Z3-ZGIv 31C1S-13-SA The account was opened on November 15, 1976. The Share accounts were held jointly by Michael C. McLaughlin and Nicole M. McLaughlin since January 19, 2010 when Mr. McLaughlin submitted a Change of Ownership form to add Nicole as his joint owner. The (L12) Auto loan-was held jointly by Michael C. McLaughlin and Nicole M. McLaughlin The( L1) Personal Service loan and (L13) Auto loan were held solely by Michael C. McLaughlin. The following are the Date of Death Balances for Mr. McLaughlin's account with PSECU: Account Date of Death Balances Interest -June 1- 10 Savings (S1) $ 200.04 $ 0.04 Money Handler (S4) $ 0.00 $ 0.00 Loans: Personal Service Loan (L1) $ 1,523.65 Auto Loan (L12) $ 12,910.92 Auto Loan (L13) $ 14,798.70 If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-7328, then press 6, extension 3120. Sin ely, £,~ Roxann Myers Service Advisor PSECU Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 1 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (TDD) psecu.com This credit union is federally insured by The National Credit Union Administration. Equal Opportunity Lender SMIGEL, ANDERSON & SACKS LLP ATTORNEYS AT LAW August 19, 2010 ING P.O. Box 990067 Hartford, CT 06199-0067 Re: Michael C. McLaughlin, Deceased Date of Death: June 10, 2010 Social Security Number: 178-38-1026 Dear Gentleperson: .~; HEATHER D. ROPER, ESQUIRE PHONE: (717) 234-2401 TOLL FREE: 1-800-822-9757 FACSIMILE: (717) 234-3611 EMAIL: hroyerC~3sasllp.com www.sasllp.com File No. 3105-13-5A Please be advised that we represent the Estate of Michael C. McLaughlin, who passed away on June 10, 2010. It is our understanding that at the time of his death, Mr. McLaughlin held an account or accounts, individually or jointly, with your institution. Please confirm in writing the following information: 1. The existence of any account or accounts with your institution, the type of account or accounts and the applicable account number(s); Account type: 401(1;) Account number: 878343 -178381026 2. The date each account or accounts were opened; 1 l /5/2007 3. The manner in which the account or accounts are titled i.e. individually or jointly; Individual 4. If held jointly, the date the account or accounts were made joint; nia 5. If held jointly, are there survivorship rights on the account or accounts; n/a River Chase Office Center, 3''d Floor, 4431 North Front Street, Harrisburg, Pennsylvania 17110-1778 A PENNSYLVANIA LIMITED LIABILITY PARTNERSHIP ING Page 2 August 19, 2010 6. The beneficiary listed on the account or accounts; and ~~/a. Beneficiary data. is maintained by the Employer - S.R. Wojdak 7. The date of death value on the account or accounts. $13,0$b.OC as of Ob/10/10 I am at this time also requesting a statement verifying the balance in each account as of Mr. McLaughlin's date of death and the date of death accrued interest amount. Mr. Mcl:.,aughlin's OG/01/2(:)10 to 0$~il `20:10 statement is included under separate copy. I am enclosing a copy of the death certificate and short certificate for your records. If you require any additional information, please feel free to contact my office at the number indicated above. Thank you for your assistance in this matter. Very truly yours, Heather D. Royer HDR/cnm Enclosures cc: Joseph P. McLaughlin, Executor -PO BOX 988 HARRISBURG, P 1 108-0988 2010/07/05 #BW NMZSX #801062050004# MICHAEL C MCLAUGHLIN 6135 WESTOVER DR MECHANICSBURG, PA 17050 ~~yz- Z~ ~Q,a!~C~ 7~ a?~~iao~c~C'd 800 900-1372 ~ Hours: Mon-Fri Sam-10pm, Sat Sam-2pm (Eastern Standard Time) _ `~~toas as ~° ~/I `sow. y ~d/ Iii o ~:~~11 ~~,t%: TEa NAt~Ot~*® CLIENT: Cumberland County TOTAL BALANCE DUE: $36.00 STATEMENT OF YOUR ACCOUNT(S) Please continue to make your monthly payments. if you wish to automate your payments please contact our office or go online at account.penncredit.com. This letter is from a debt collection agency. This is an attempt to collect a debt. Any information obtained will be used for that purpose. SERVICE RENOEREO LAST PAYMENT ACCOUNT NUM6ER OALANCE 2009 CNTY & TWP PER CAPITA TAX 2009/00/00 7191031509 $36.00 ~~ 1~ ~, Detach and return with payment to expedite credit to your account 2010/07/05 MICHAEL C MCLAUGHLIN 6135 WESTOVER DR MECHANICSBURG, PA 17050 ID NUMBER: 80106205 BALANCE DUE: $36.00 Pay online at http://account.penncredit.com If you wish to pay by credit card in the mail, please enter the requested information in the spaces provided. Check one: ^ Visa ^ Mastercard Card #: ---------------- Expiration Date: / / Signature: 801062050004 PENN CREDIT CORPORATION jT MPC `~ APR-01-2011 08 58 QUANTUM IMAGING AND THERAPEUTIC ASSOCIATES 624D I.OWTHER ROAD LEWISBERRY, PA 17339 {g77)932-5955 Patient: Acct ti: 261183 MCLAUGHLIN~MICHAEL C 6135 WESTOVER DRIVE MECHANIC5BURG,PA 17050 Responsible party: MCLAUGHT.IN, MICHAEL C 6135 WESTOVER DRIVE MECHANICSBURG, PA 17050 P. 02 Srvc. Date Proc. Code Pxoc, Description Charge aaXance Physician 04J07/2010 71020 CHEST 2 VIEWS PA & LATERAL $45.04 $95.00 DURISEK, DEBBIE L TOTAL BALANCE: $4 5 00 Print Date: OA/01/2011 This report has been Reproduced from the Original Reproduced Friday, April 1, 2011 09:17:23 AM (chenry) Page 1 of ~, TOTAL P.O2 BUREAU OF ACCOUNT MANAGEMENT 3607 Rosemont Avenue, Suite 502 PO Box 8875 Camp Hill, PA 17001-8875 Telephone: 1-717-214-3017 Toll free: 1-800-599-0423 Monday -Thursday 8:30 - 8:30 (EST) Friday 8:30 - 5:00 (EST) July 12, 2010 Michael Mclauthlin 6135 Westover Dr Mechanicsburg, PA 17050-2373 In Re: Milton S Hershey Med Center Amount Due :$380.35 Account # :27268381 Client Ref. # :14018652-1 * Please see reverse side for important account information. Michael Mclauthlin Your account has been placed with this office for collection. This notice has been sent to you by a debt collection agency. Payment in full is being requested to resolve this fast-due account. If payment in full is not received this account maybe repported as "placed for collection' with the credit bureaus. This "unpaid account" information and your paymenthistory on this account will then be available for review by the business community. If you have any questions call our office using the account # as a reference to your file. Unless you notify this office within 30 days after receiving this notice that you dis ute the validity of this debtor any portion.thereof, this office will assume this debt is valid. If ou notify this office in writing within 30 days from receiving this notice, this office will: obtain verification ofythe debtor obtain a coppyy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, if different from the current creditor. This is an attempt to collect a debt by a debt collector and any information obtained will be used for that purpose. Your payment should be made directly to this office for prompt credit to your account. Atwenty-dollar service charge will be added to all checks returned to us by our bank. Should you desire areceipt, aself-addressed, stamped envelope is required. Bureau Of Account Management ------------------------Detach and Return with Payment------------------------------ ------------------------------ ------------------------ PO Box 8875 Camp Hill, PA 17001-8875 Return Service Requested PERSONAL & CONFIDENTIAL Michael Mclauthlin 2726s381 6135 Westover Dr Mechanicsburg, PA 17050-2373 6~~III~~~IIh~~~I~hII~~~~~hhdl~I~~~h~Ih~~ILd~l~~6~l1 To pay by credit card, please complete the information below: Check one: ^ Visa ^ MasterCard Card Number: _______________ Expiration Date: / / Payment Amount: Signature: Amount Due : $380.35 Account # Client Ref. # :14018652-1 Amount Enclosed : $ Bureau of Account Management PO Box 8875 Camp Hill, PA 17001-8875 I~~~IIh~~III~~d1~~~~~~116~hI~J~6~~l~hhh~~l~l~h~~~111 :27268381 OIlT!`Qf1~ !1!1/11 l1GD i 7BA flf1/1(1C9 109 l17GGAG 7!`OC IF PAYING BY MASTERCARD OR VISA, FILCOUT BELOW. CHECK CARD USING FOR PAYMENT CENTER CITY DENTAL CARE 227 PINE ST. HARRISBURG, PA 17101-1353 RETURN SERVICE REQUESTED o2oz PAYMENT DUE DATE: 06-24-10 14733-Q688 _ ^ -~ MASTERCARD l~!!a ^ ~ VISA CARD NUMBER SIGNATURE CODE SIGNATURE - __ EXP. DATE STATEMENT DATE 06-09-10 PAY THIS AMOUNT $ 3 8 0.18 ACCT. # FOR BILLING INQUIRIES, PHONE 717-232-2991 PAGE: 1 of 2 SHOW AMOUNT PAID HERE zooooz~ ~lilllll~llllllllrlulllllllll~li~ll~~ll~ll~lu~~lrlll~lll~llll MICHAEL MCLAUGHLIN 6135 WESTOVER DRIVE MECHANICSBURG, PA 17050-2373 ('~ Please check box if address is incorrect or insurance U information has changed, and indicate change(s) on reverse side. I_ _ _ -_ _ _ DATE I PATIENT NAME 11/26/08) 11L26/08 Michael 01/08/09 Michael 06/09/10 Michael 12/12/08 Michael 12/12/08 Account 01/08/09 Michael 01/08/09 Michael 06 /1 f,/~ Michael 1 Michael 12/12/08 01/08/09 Michael 06/09/10 Michael 07/31/09~Michael 06/09/10 Michael 06/16/09~Account lllll~lllll~llll~lllllll~llirl~llnlll~lll~ll~rrn~l~n-I~n~l CENTER CITY DENTAL CARE 227 PINE ST. HARRISBURG, PA 1 71 01-1 353 14733-Q688*TYEOXNOX0000411 STATEMENT PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT DESCRIPTION PREVIOUS BALANCE L Partial Cast Acrylic Total fees for 11-26-08 Primary ins pmt: DELTA DENTAL Insurance summary:A claim of $826.00 for charges incurred on 11-26-08 was submitted to DELTA DENTAL on 11-26-08. They paid $340.00. Periodic Oral Evaluation Panoramic x ray Total fees for 12-12-08 Primary ins pmt: DELTA DENTAL Insurance summary:A claim of $82.00 for charges incurred on 12-12-08 was submitted to DELTA DENTAL on 12-12-08. They paid $23.00. Delta Participating Adjus Courtesy (12/12/08) Delta Participating Adjus (11/26/08) .Periodic Oral Evaluation Total. fees for 06-16-09 Primary ins pmt: DELTA DENTAL Insurance summary:A claim of $25.00 for charges incurred on 06-16-09 was submitted to DELTA DENTAL on 06-16-09. They paid $23.00. Delta Participating Adjus CHARGE I PAYMENT AMOUNT AMOUNT 26.0 340.00 25.00 57 0 82.00 23.00 _- CURRENT ~ PATIENT BALANCE _ BALANCE -o.oo -o.oo 826.00 486.00 486.00 486.00 486.00 568.OOI 545.00 545.00 545.00 545.00 2.00 543.00 57.00 486.00 146.00 340.00 5.00 5.0 365.00 23.00 342.00 342.00 CURRENT 30-DAY 60-DAY 90-DAY TOTAL INSURANCE BALANCE PENDING $4.26 $5.21 $3.79 $366.92 $380.18 $0.00 543.00 486.00 340.00 342.00 342.00 2.OOI 340.OOI 340.0.0 __ DEFERRED ~OII~ j~DUE FROM PATIENT ~ $0.00 ~~------- $380.18) h ~ 375.92 of your balance is now past due. Please pay this amount immediately. In addition, 4.26 of your balance is due in our office no later than 06-24-10. If you have a secondary insurance that we do not know about, please let us know. ~~ ~ 3 ~ ~~ 14733-Q688*TYEOXNQX0000411 ~ ~~II~~~~N~gyq~y®~~~~ ~~ ~~ ~ .~ STATEMENT OF ACCOUNT AQUA SPECIALISTS, INC. 160 SILVER SPRING RD P.O. BOX 123 MECHANICSBURG, PA 17050 Telephone 717/766-2541 Bill To MIKE McLAUGHLIN 6135 WESTOVER bRIVE MECHANICSBURG, PA 17050-2373 Remit To AQUA SPECIALISTS, INC. 160 SILVER SPRING RD P.O. BOX 123 MECHANICSBURG, PA 17050 Please detach and return with payment Amount Enclo d Page 1 Statement Date Account No. 06/01/10 MCLAM1 Last Payment: 01/07/10 for $68.00 Statement Date Account No. 06/01/10 MCLAM1 lhvoice No. Balance X 906576 110.78 ~~ IN THE.000RT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~' ;~ ESTATE OF , ~- MICHAEL CMCLAUGHLIN ,Deceased No. 2010-00635 of 20 ' G' To the Clerk of the Orphans' Court: Enter the claim of CAPITAL ONE BANK (USA) NA In the amount of $2,243.52 ,against the above entitled estate. The decedent, who resided at PO BOX 790 HARRISBURG PA 17108 Acct. 4791242318483792 died on 06/10/2010 .Written notice of said claim was given to JOSEPH MCLAUGHLIN C/O H ROYER ,if known to claimant, at (Personal Representative or counsel) 4431 N FRONT ST, HARRISBURG, PA 17110 on September 13, 2010 (Date) (Claimant) Address: 2323 Lake Club Drive, Suite 300 Columbus Ohio 43232 Claimant's Counsel Address AMENDED CLAIM COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: Court File No: 21 2010-0635 MICHAEL C MCLAUGHLIN Deceased TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Cade, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: creditor(s) listed on attached claim detail 2} Claimant's address: C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200 MINNEAPOLIS MN 55422 3) Creditor listed below is the owner and holder of a claim in the amount of $ 1,149.81 4} The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. See attached claim detail for claim basis and/or supporting Affidavit statement 5) Decedent's address: 6) Date of Death:6/10/2010 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by. On behalf of the claimant, I do solemnly declare and affirm under the penalties of perjury that they Information and representations made herein are true and correct to the best of my knowledge, information and belief. ~ ,, l Stephanie A. Johnson Dated : ~ ~~10 ~'~ ~'v Authorized R resentative laimant Written notice of claim was given to Personal pr sentative and/or his/her counsel as stated below: STUART S SACKS Name 4431 N FRONT ST 3RD FLOOR Address HARRISBURG, PA 17110 City/State/Zip ~~7. ~~ Date notice mailed _ s fi, `, a COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: Court File No: 21 2010-0635 MICHAEL C MCLAUGHLIN Deceased TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b}(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: creditor(s) listed on attached claim detail 2) Claimant's address: C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200 MINNEAPOLIS MN 55422 3) Creditor {fisted below is the owner and holder of a claim in the amount of $ 3,095.28 4) The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. See attached claim detail for claim basis and/or supporting Affidavit statement 5) Decedent's address: 6) Date of Death:6/10/2010 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by. On beha{f of the claimant, I do solemnly declare and affirm under the penalties of perjury that they Information and representations made herein are true and correct to the best of y kno ledge, information and belief. Adige L. Fliiott Dated: 2~J C7 Authorixad Rr~p~otet~vc CI imant Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: STUART S SACKS Name 4431 N FRONT ST 3RD FLOOR Address HARRISBURG, PA 17110 City/State/Zip 7 ~ 4'. r~ Date notice mailed ,~ ~. ~ , ~ ,"?~ ~ ~ -- ~._ n ; . ~. ., ,~. _,_ ' ~., ~ ~, .. ~ i. FORM 93-0. C. DIVISION IN THE COURT OF COM'INON PLEAS QF CUMBERLAND GOUNTY,'~ENNSYLVANIA (3RPHANS' COURT DIVISION IN RE: ESTATE OF Estate No. 2010-00635 MICHAEL MCLAUGHLIN (Deceased) CLAIM To the Clerk of Orphans' Court Division: Index and make proper entry in your official records of the claim of WEST ASSET MANAGEMENT, INC. for AMERICAN EXPRESS, (Claimant) account #371388734972003, in the amount of X7,805.73, against the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 6135 WESTOVER DR. MECHANICSBURG. PA 17050-2373, died on 06-10-2010. Written notice of this claim was given to JOSEPH MCLAUGHLIN JR. at 4431 N FRONST ST 3RD FLOOR, HARRISBURG, PA 17110 on 08-19-2010. (Personal representative, if any, or counsel). (Claimant) West Asset Management, Inc. 7171 Mercy Road, PO Box 6183 Omaha, Nebraska 6$106-0183 1-800-878-3317 (Claimant's Address) I~ (,. FORM 93-0. C. DIVISION IN THE COURT OF COMI~C7~[~1 PLEAS Qf- CUMBERLAND BOUNTY,` PENNSYLVANIA ORPHANS' ~t)tJRT DIVISION IN RE: ESTATE '' OF Estate No. 2010-00635 MICHAEL MCLAUGHLIN (Deceased) CLAIM To the Clerk of Orphans' Court Division: Index and make proper entry in your official records of the claim of WEST ASSET MANAGEMENT, INC. for AMERICAN EXPRESS, (Claimant) account #371732396381005, in the amount of $5,205.65, against the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of 1949 as amended. The said decedent, who resided at 6135 WESTOVER DR, MECHANICSBURG, PA 17050-2373, died on 06-10-2010. Written notice of this claim was given to JOSEPH MCLAUGHLIN. at 4431 N FRONST ST 3RD FLOOR, HARRISBURG, PA 17110 on 08-19-2010. (Personal representative, if any, or counsel). (Claiman ) West Asset Management, Inc. 7171 Mercy Road, PO Box 6183 Omaha, Nebraska 68106-0183 1-800-878-3317 (Claimant's Address) $,ankofAm is CH03b 3/8/2011 1:30:33 PM PAGE 11001 Fax Server ~ :lrburtnsy Mah ey COMPANY Banknfalmel'iCa Newaooauntnumher: 4888937997507882 www_hsnlEaFsme Aca_aom Oldecccunt numt5er. ESTATE OF MICHAEL ~ MCLAUGHLIN 4888939024412797 8135 V-+ESTaDVER DR MECHANICSBURG PA 17450-23733 March 48, 2{}11 Dear Estate of Michael C McLaughlin: Please advise us of the status of the Estate of Michael C McLaughlin and whether funds are available to pay our claim of $1,584.44. If funds are available io pay the claim, please send paymerrt by express seroioe to Bank of America, 1fl~04 Samoset Drive, Wil mingtan, DE 1884-2331, A1TN: PDP. As a reminder, please plane the new acc~aunt number an the payment. Be advised, whether or not, you are the personal representative, executor ar attorney handling the affairs of the decadent, you are not personally responsible for this debt. if you have any questions, or would like fin arrange far payment aver the phone, please call 1.888.221.4,265 Monday through Thursday 8 a.m. to 8 p.m. and Friday 8 to 5 Eastern. If you prefer, you may write to Bank of America, P. O. Box 15485, Viii Imingtan, DE 1688.5445. Our experienced associates are ready too assist you. Si ncen}ly, Rlck Campbell Estate Department ~n escu ~-~ us+~ ~oooaoaooaooc- oaao $ankofAmer ca CHOOa 3/8/2011 T9:C~urtney Mah a COMPANY: 1:32:23 PM PAGE Bankof~irnerica www.ban IuSFame ~ica.com ESTATE OF MICHAEL C MCLAUGHLIN 8135 WESTflVEk DR MECHANICSBURG PA 17~50~-237335 March {XB, 2{}11 Dear Estate of Michael C McLaughlin: 1/001 Fax Server New account number: 5329041998931007 Old account number: 5329041277201843 Please advise us of the status of the Estate of Michael C McLaughlin and whether funds are available fia pay our clai m of $4,98(}.4)•3. If funds are available so pay the claim, please send payment by express service to Bank of America,1{f{f{} Samaset Drive, Wilmington, DE 19~884~2331, ATTN: PDP. As a reminder, please place the new account numberon the payment. Be advised, whether or not, you are the peraanal representative, executor or attorney handling the affairs of the decedent, you are not personal ly t~asponsible for this debt. If you have any questions, or would like to arrange far payment over the phone, please call 1.8i3t3.221.4299 Monday through Thursday 8 a.m. to 8 p.m. and Friday 8 to 5 Eastern. ffyou prefer, you may write to Bank of America, P. a. Box 154~,1Ni Imington, DE 19~88.5,6M?9. Dur experienced associates are ready to assist you. Sincerely, Rick Campbell Estate Department men escu ~-~ us-ou ~- o000