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Home My WebLink About03-0492- PETITION FOR PROBATE and GRANT OF LETTERS Estate of .Jean I. Swartz also known as No. ,.~1-0.~ -I~q~L. To: Register of Wills for the Social Security No. 208-1~-9120 , Deceased. County of Cumberland · Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrix in the last will of the above decedent, dated Auqust 28, 1995 and codicil(s) dated NONE in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with h.er last family or principal residence at 506 Cocklin Street Mechanicsbur Mechanlcsbur (list street, number and municipality) Decedent, then 78 years of age, died 6/.__8/03 at Carlisle Re ional Medical Center Carlisle PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never ajudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: __ $ 174,000.00 $ NONE WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARY thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Donna J. Nailor, 506 Cocklin Street Mechanicsbur.q PA t7055 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA t ss COUNTY OF Cumberland The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,,.~me this I q ~ Z (~:% day of Bann~ .7 No. ~1-03- qq~ Estate of J~ean I. Swartz , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW _ x~\~ ~ ~x ~. 1-1, ZOO,3 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated B. 128195 described therein be admitted to probate and filed of record as the last will of-lEAN I. SWAR'r7 and Letters TESTAMENTARY are hereby granted to Donna J. Nailor FEES Probate, Letters, Etc ......... $ ~.:~%. tX_3 Short Certificates ( ) ...... $ I,.~ .oo TOTAL $ ~ Filed...~, -l.w.- .o.~. MURREL R. WALTERS III #-~4~49 ATTORNEY (Sup. Ct. I.D. No.) 54 EAST MAIN STREET MECHANICSBURG PA 17055 ADDRESS 717-697-4650 PHONE ~at tT~e h~£ormation here given is correcdv conied from ' · · or,gin ~1 certificate will be J r _ . an ong~n, al cemficate of death dui filed with me as ' ' ~ ' ' forwarded to the State V~tal Records Office for permanent ~ng. ~VARNING: It is illegal to duplicate this copy by photostat or photograph. this certificate, $2.00 P 9330811 No. Local Registrar 16 2c¢, 3 , Date Swartz COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 78 i Carlisle Clerical 506 Cocklin Street ! Mechanicsburg, PA 17055 ,.. Sumner H Wance 9128/1924 __Female 208 -- 14 -- 9120 Carlisle Regional Medical Center 12~'~ ~' "'" Widowed ,,.. ~ Pe~lvania - '~' ,,c.~ ~ ,:,.~,,..~,. ,,,.~9 ,~'~ Mechanicsburg M. 506 Cocklin Street Mechanicsburq, PA 17055 White June 11, 2003 Chestnut Hill Cemetery Mechanicsbur~t PA 1705 5 ". ~,~ *~ ~ L~ST WILL i~D TEST~IENT BE IT REMEMBERED THAT I, JEAN I. SWARTZ, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I declare that I am not married, my beloved husband, WILLIAM A. SWARTZ, having predeceased me, and that I have two children, DONNA J. NAILOR and MARK W. SWARTZ. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give and bequeath items of personal property to my children as follows: To my daughter, DONNA: all my jewelry, all my clothing, my bedroom suit with extra chair, cedar closet wardrobe, dough tray, green flowered pitcher and bowl set with all matching pieces which are in my bedroom, all other pitcher and bowl sets, brown and white crock, set of Nortocki China (white on white), clear glass serving dishes, VCR, stereo, and large guardian kettle in basement closet, per capita; To my son, MARK: kitchen set, refrigerator, dining room suit with desk, living room suit, end tables and coffee table, lamps in living room, television in living room and family room, bedroom suit in smallest bedroom, family room furniture, ping-pong table, gas grill, lawn mower, and snow blower, per capita. V I give to my son, MARK, the opportunity to purchase my residence at its fair market value. He will have the option of offsetting his inheritance against the value of the real estate. VI Ail the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise, and bequeath to my daughter, DONNA, and my son, MARK, in equal shares, per capita. VII I nominate, constitute and appoint my daughter, DONNA, as Executrix of this LAST WILL, to serve without bond. If my daughter is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my son, MARK, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, JEAN I. SWARTZ, have set my hand to this LAST WILL this ~ ~/~ day of ~t~ ~ , 1995. JEAN Signed, sealed, published and declared by the above-named JEAN I. SWARTZ, as and for her Last Will and Testament, in the presen.ce of us, who, at her request and in her presence, and in the presence have hereunto subscrib~d~ur names as witnesses. of each other, ~~/~~f ~// ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : I, JEAN I. SWARTZ, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. j Sworn or affirmed to and acknowledged before me by JEAN I. SWARTZ, Testatrix, this ~ day of /~&(.s~ , 1995. Notarial Seal Diane M. Smith, Notary Public Mechanicsburg Boro, Cumbe~nd County My Commission Expires June 22, 1996 ~FFIDAVIT COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : We, /)7~.~rt~/ ~. ~c~/'~f~ Z~ and ~. /)'~ ~ ~ 0~-~J , the witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL; that JEAN I. SWARTZ signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing/and. sight of the Testatrix signed the Will as witnesses; and that t~;/ the best of our knowledge, the Testatrix ~as at the time 18/ye~s ~f age or more, of sound mind and under/no constraint oV~ue influence. ~~~~/ Sworn or affirmed to and acknowledged before me this ~day of /~.c~.~' ~ , 1995. Notary Public Seal N0mry Public Cum~da~ Cou~ ~res June 22, 1 LAST WILL AND TESTAMENT JEAN I. SWARTZ '03 JUi~ 17 ?12:48 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JEAN I. SWARTZ Date of Death: June 8, 2003 W'fll No. 2003-00492 Admin. No. 21-03-0492 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 20, 2003. Name Address DonnaJ. Nailor 506 Cocklin Street, Mechanicsburg, PA 17055 Mark W. Swartz 965 S. 29t~ Street, Camp Hill, PA 17011 Notice has now been given to all persons entitled the, re~/m Lder.,~R~e/5.6(~xcept: Date: July 8, 2003 Murrel R. Wal~ers, III, Esquire 54 East Main Street Mechanicsburg, PA 17055 (717) 697-4650 Capacity:. Personal Representative X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003306 WALTERS MURREL R III ESQUIRE 54 E MAIN STREET MECHANICSBURG, PA 17055 ........ foJd ESTATE INFORMATION: SSN: 208-14-9120 FILE NUMBER: 2103-0492 DECEDENT NAME: SWARTZ JEAN I DATE OF PAYMENT: 12/04/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,934.24 REMARKS: TOTAL AMOUNT PAID' DONNA J NAILOR EXEC. C/O MURREL R WALTERS III ESQUIRE $7,934.24 SEAL CHECK//103 INITIALS: JA RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ,., I REv-I nn DEPARTD EpNT "20 F06RoE yE"UN I INHERITANCE TAX RETURN HARRISBURC, PA 7128-0601 RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SWARTZ.;_JEAN I. DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DO-Year) 06~08~2003 0912811924 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [~-ll. Original Return 1~4. Limited Estate ~-'~6. Decedent Died Testate (Attach copy of Will) '--]2. Supplemental Return J---~ 4a. Future interest Compromise (date of death a~ter 12-12,82) Lr"'~ 7. Decedent Maintained a Living Trust (Attach copy of TnJst) FILE NUMBER OFFICIAL USE ONLY 2 I -O 3 0 4 9 2 '"~'TY C'~'~ y"~-- NUMAR-- ~ SOCIAL SECURITY NUMBER 2 O 8 - I 4 - 9 I 2 O THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r-'] 3. Remainder Return (date o~'death pdor to 12-13,82) ~"~ 5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes r--) 9. Litigation Proceeds Received ['"-) 10. Spousal Poverty Credit (date of dealh between 12-31-91 and 1-1.95) [~ 11, EJection to tax under Sec. 9113(A)(Attach Sch O) THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME MURREL R. WALTERS III ESQ FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS TELEPHONE NUMBER 717/697-4650 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship {3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r'-] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 54 EAST MAIN STREET MECHANICSBURG 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 191,273.20 PA 17055 OFFICIAL USE ONLY (8) (11) :, (12) (13) (14) 191,273.20 12~556.28 2;400.44 14,956.77 176,316.4~! 176,316.48 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20, x ¢5) 176~316,4R X .O45 (16) X .12 (17) X m ~ 5 (18) ,, (19) BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH 7,934.2~ 7,934.2~ Pecedent's Complete Address: STREET ADDRESS 506 COCKLIN STREET CIT~ MECHANICSBURG STATE PA ~ Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) 2. Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount (1) 7;934.24 3. Interest/Penalty if applicable Total Credits ( A + B + C ) (2) D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or .................................................................................................. [] [] d. receive the promise for life of either payments benefits or care? ' [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary des gnat on? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMP ~, ...... LETE SCHEDULE G AND FI Under penalties of ru Ideclare .... LE IT AS PART OF THE RETURN. · pe ] ry, that I have exam ned th~s return ~nclu .... ~ ~ Declaration of re rer other . . , ding accompanying schedules and statements and . ~ ~' ' ~ ~i~'(~'~'¢ ~t~ich preparer has any kno~ledn~O the best of my knowledge and belief, it is true, correct and complete. SIGNATURE OF PERSON ~kESPONSIBLE FOR FILING RET ~J ................. ' ~ ' ~ _..._..__._. ADDRESS DONNA ,J,I~A;L~F~ ',/' -- 11'26'03 BURG PA 17055 ADDRESS MURREL WALTERS III 6/03 7,934.24 7,934.24 54 EAST MAIN STREET, MECHANICSBURG PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an indMdual who has at least one parent in common with the decedent, whether by blood or adoption. E¥-15~ E)~ + (1-97) . ~ I CAS ISC. OMMONWEALTH OF PENNSYLVANIA / CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN I n ~ n ~ A · m ESTATE OF ~1. FILE NUMBER include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F, ITEM NUMBER DESCRIPTION VALUE AT DATE 1. MEMBERS 1ST FEDERAL CREDIT UNION OF DEATH SAVINGS 31.63 2 MEMBERS 1ST FEDERAL CREDIT UNION INVESTMENT SAVINGS 12,332.60 3 FULTON BANK CD 12,526.93 PNC BANK CHECKING 16,097.94 5 PNC BANK IRA BENEFICARIES DONNA J. NAILOR & MARK W. SWARTZ FULTON BANK ANNUITY BENEFICIARIES DONNA J. NAILOR & MARK W. SWARTZ WADDELL & REED INVESTMENT ACCOUNT 1,161.60 79,296.42 69,826.08 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) 191,273.20 ~EV'I511EX~* (1'97) ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: 1. PREPAID MALPEZZl FUNERAL HOME 2 FUNERAL DINNER SCHEDULE H I FUNERAL EXPENSES & J ADMINISTRATIVE COSTS FILE NUMBER DESCRIPTION 21 4 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) DONNA J. NAILOR Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 506 COCKLIN STREET 202365883 City MECHANICSBURG State PA Year(s) Commission Paid: 2004 Attomey Fees MURREL R. WALTERS ESQ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip 17055 Street Address City Relationship of Claimant to Decedent Pmbata Fees REGISTER OF WILLS CUMBERLAND COUNTY Accountant's Fees State Zip Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) AMOUNT $ 91.28 8,640.00 3,500.00 325.00 (If more space is needed, insert additional sheets of the same size) 12,556.28 '~' I SCHEDULE I COMMONWEALTH OF PENNSYLVANIA I DEBTS OF DECEDENT. ~ FILE NUMBER Include unreimbursed medical expenses, ITEM NUMBER 2 5 DESCRIPTION SARAH TODD NURSING HOME RESIDENTIAL CARE WEST SHORE EMS MEDICAL CARLISLE FIRE AND RESCUE AMBULANCE CENTRAL PENN MEDICAL CENTER MEDICAL CHECK PRINTING MASLAND ASSOCIATES MEDICAL CENTRAL PENN MEDICAL EMERGENCY MEDICAL TOTAL (Also enter on line 10, Recapitulation) AMOUNT 2,169.10 139.35 28.38 36.44 7.25 1.70 18.22 (If more space is needed, insert additional sheets of the same size) 2,400.44 R. EV-1513 EX + (91~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under 2 Sec. 9116 (a)(1.2)] DONNA J, NAILOR 506 COCKLIN STREET MECAHNISCBURG~ PA 17055 MARK W, SWARTZ 965 SOUTH 29TH STREET CAMP HILL~ PA 17013 II. SCHEDULE J BENEFICIARIES --____._ 21 O3 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER SON AMOUNT OR SHARE OF ESTATE 50% 5O% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX D/VIS/OH DEPT. ZSO60X HARRISBURG, PA 17128-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HURREL R WALTERS III 5q E HAIN ST HECHANICSBURG ESQ PA 17055 DATE 01-Z7-ZOOq ESTATE OF SWARTZ DATE OF DEATH 06-08-2005 FILE NUMBER 21 05-0~92 COUNTY CUHBERLAND ACN 101 Amount Ree:L ~'lced JEAN HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGI'STER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THXS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15q7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF SWARTZ JEAN I FILE NO. 21 05-0~92 ACN 101 DATE 01-27-200~ TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAXSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Par~nership In~eres~ (Schedule C) ($) q. Mortgages/No,es Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/M/sc. Expenses (ScheduZe H) (9) 10. Deb~s/Hor~gage Liabilities~Liens (Schedule X) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn .00 .00 .00 .00 191z275.20 .00 .00 12,556.28 NOTE: To insure proper credit ~o your account, suba{~ ~he upper portion of ~his fore with your ~ex payment. 13. lq. NOTE: 191,273.20 Z,~O0.qR (11) ]~.956.72 (12) 176,516.~8 Chari~able/governeen~al Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) Ne'l: Value of Esta~:e SubSect to Tax (lq) I~ an assessment was lssued previously, 1/nas lq, 15 and/or 16, 17, re~lect ~igures that lnclude the total o~ ALL returns assessed to date. .00 176,516.~8 ASSESSHENT OF TAX: 15. Aaoun~: of Line lq a~: Spouse1 rate 16. Aaoun~ of Line Xq taxable a~ Lineal~Class A ra~:e 17. Aaount of Line lq a~: Sibling rate 18. Aaount of Line lq taxable e~c Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECETpT Dx$COUNT DATE NUMBER TNTEREST/PEN PAID (- 12-0q-2005 CD005506 . 18 and 19 will (2s), .00 x 00 = .00 (~6). 176,516.q8 x 0q5= 7,95q.Zq (~7), .00 x 12 = .00 (~8), .00 x 15 = .00 (19): 7,95q.Zq AMOUNT PAID 7,95q. Zq ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDXT 7,934. Zq BALANCE OF TAX DUEI .00 XNTEREST AND PEN. .00 TOTAL DUE .00 ( XF TOTAL DUE XS LESS THAN $1, NO PAYMENT TS REQUIRED. TF TOTAL DUE TS REFLECTED AS A 'CRED/T' (CR), YOU MAY BE DUE ~_ A REFUND. SEE REVERSE STDE OF THIS FORM FOR TNSTRUCTXONS. } RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CA): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: D/SCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for 1ifa ar for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-151$). Applications arm available at the Office of the Register of Hills, any of the 15 Revenue District Offices, or by ceiling the special Iq-hour answering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / ar speaking needs: 1-800-qq7-S020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) es shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board cf Appeals, Dept. 181021, Harrisburg, PA 17118-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Indlvidual Taxes, ATTN: Post Assessment Review Unit, Dept. ze06D1, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day cf delinquency, or nine (9) months and cna (1) day from the date cf death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016q. A11 taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2005 are: Interest Oaily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 2:07. .0005q.8 1987 97. .0002:6,.7 1999 77. .00019Z 1985 16Z . 000~58 1988-1991 117. . 000301 2000 87. . 000119 198~ 111 .000501 199Z 97. .0001~7 ZOOZ 91 .0001~7 1985 157. .000356 1995-199~ 77. .000192 ZOOZ 67. . OO016q 1986 107. .00027~ 1995-1998 97. .000Z~7 2003 57. . 0001~7 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must ba calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/03/2005 WALTERS MURREL RIll 54 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of SWARTZ JEAN I File Number: 2003-00492 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 6/08/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER ~TRASB~H- REGISTER OF WILLS cc: File Personal Representative(s) Judge ~ PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: JEAN 1. SW ARTZ June 8, 2003 Estate No.: 2003-00492 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes__X___ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete (date) 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No_X___ B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. in interest: Did the personal representative state an account informally to the parties Yes_X___ No D. Copies of receipts, releases, joinders and approvals of formallnformal accounts may.be filed with the Clerk of the /ans' Cour hd may be attached to tlus report. >>/7 / /~ Dare: 1:;f ,~I ;) <'- C). ~.......... MURREL R. W ALTERS, III, ESQUIRE 54 East Main Street Mechanicsburg, P A 17055 717-697-4650 Capacity: Personal Representative _X_ Counsel for Personal Representati1