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Home My WebLink About03-0912STATUS REPORT UNDER RULE 6.1~ Name of Decedent: Hannelore A. Swanger Date of Death: October 12, 2003 Will No. 2003-00912 Admin. No. 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 Yes x No 2.. If the answer is No, state when the personal representative reasonably believes that the complete: complete: administration will be 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 b. The separate Orphans, Court No. (if any) for the personal representative,s account is: c. Did the personal representative state an account informal.ly to the parties in interest? Yes_ X No d. Copies of receipts, releases, joinders and' approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 11/23/04 _ Signature (MAH:rmf/AM3) Debra K. Wallet, Esq. Name (Please type or print) 24 N. 32nd St., Camp Hill, PA 17011 Address ~17 ) 737-1300 Tel. No. Capacity: Personal Representative _Counsel for personal representative ~ PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Hannelore A. Swanger also known as Deceased. Social Security No. !6A-30-5!84 No. To: Register of Wills for the County of C~rahorl ~nd in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl 5e~q for letters of administration on the estate of (d.b.n,; pendente lile; durante absentia; durante minorilate) the above decedent. Decedent was domiciled at death in Cumberland County, Pennsylvania, with ker last family or principal residence at 230 Brian Drive, E,2o!a, PA !7025 {list street, number, Twp. or Boro.) Decedent, then 79 years of age, died o,-~-,~hor at 230 Br-~n Dr-~vo; F. nnl~, PA 17025 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: None Petitioner the ~llowingspouse(ifany) and heirs Name Lica Farber after a proper search ha a ascertained that decedent left no will and was survived by Dcug!as Swanger Relationship Son Residence 9 Wh~pnr~rw-;ll Bravo 22! ~wxrosr l.nno Ch~mhor~hurff: PA 17201 930 g~n Dr~V~ Enola~ PA 17025 THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. 230 Brian Drive, P.O. Enola, PA 17025 Box 68 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF 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 representative(s) of the above decedent petitioner(s) will well and truly administer the estate occording to law. Sworn to or affirmed and subscribed befor~ ~me this ~-~/~ day of Regtster Estate of Hannelore A. Swanger ~ I~e~eu~ GRANT OF LETTERS OF ADMINISTRATION AND NOW ~~J~'~ ~, in consideration of the petition on the reverse side h~re~f, satisfactory proof having been presented before me, IT IS DECREED that ~obert L. Sw~,,~r is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Robert L. Swanger in the estate of Hannelore A. Swanger FEES Letters of Administration ..... $ _~k~.~ Short Certificates( ) .......... $$~~- Renunciation ................ Filed~ff. ~ ...........TOTAL A.$D~ Debra K. Wallet ~23989) ATTORNEY (Sup. Ct. I.D. No.) 2~!:'':-N~. 32n3 street, Camp Hill,, PA ADDRESS 17011 717-737-1300 PHONE RENUNCIATION In Re Estate of Hannelore A. Swanger deceased. To the Register of Wills of CumberlandCounty, Pennsylvania. The undersigned Lisa Farber and Douglas Swan_~er: nh~lHr~n of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Robert Swan~er WITNESS hand this /'~,7~ day of ~,9.~- C~.~..~.Y~ 2003 Subscribed and sworn to before me this /77l~ day of ~C-~O~CZ ~ 2003 Notarial Seal Shirley Keys, Notary Public Hampden Twp., Cumberland County My Commission Expires June 17, 2004 Mol'nbe~, Pe~.sy va. a AssociatJon et Notaries (Signatufe) (Address) (Silmalute) (Address) (Signature) his is to certify that the information here 'given is correctly copied from an original certificate of death duly, filed with me as Local Registrar. The original .certificate will be forwarded to the State 'Vital .Records Office for permanent filing. WARNING: It is illegal t° duplicate this copy by photOstat or photograph. Fee for this certificate, $2.00 P 9593911 No. Local Registrar Date ~.' Karl Sokroeder MOTHER'S NAivlE (Firr, l, Mi~lle, Maiden iumaa) · ,,. ~na Velser ~ j~o. Ro~rt L. Sw~ger la~. ~u~rz~ urlve~mo~a, r~ ~/uz3 ' // 2~b. ~tober 16~ 2003 2,~. ~odla~ ~ete~ 2,a. Milroy: PA 17~3 I COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH -~ STATE FlEE NUMBER . ~E OF OE~EDENY (Flr~,, Middle tas[) · ] SEX ] SOCIAL SECURITY NUMBER [DATE 6F D~TN ~.[.; ~,, }~nn~lore. A. Swan~er [~ F~le [3 164 - 30 - 5184 [~. ~tober 12, 2~3 230 Brian Drive .~s,o~.c~ Other ($~eci~y) ~ ER E E CT .... S SUCH UCENSE.t~U. ~,~8/~ __N~E ~D ADDRESS OF 'ACLU" ' , ~le~el ~er not resull~g in Iht underlying cause given in PART I. .'lC BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RUI~E 5.6(a) Name of Decedent: Date of Death: Will No. Hannelore A. Swanger October 12, 2003 2003-00912 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 2, 2004. Name Address Robert L. Swanger 230 Brian Drive P.O. Box 68 Enola, PA 17025 Douglas Swanger 221 Harvest Lane Chambersburg, PA 17201 Lisa Farber 9 Whipoorwill Drive Worcester, MA 01606 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: February 2, 2004 Debra K. Wallet, Esquire 24 N. 32nd Street Camp Hill, PA 17011 (717) 737-1300 Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28O601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003432 WALLET DEBRA K 24 N 32ND ST CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 164-30-5184 FILE NUMBER: 2103-091 2 DECEDENT NAME: SWANGER HANNELORE A DATE OF PAYMENT: 01/1 2/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/12/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $616.70 TOTAL AMOUNT PAID: $616.70 REMARKS: CHECK//110 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 Z REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 03 00912 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ! Swanger, Harmelore A. 164-30-5184 ~" DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) ~ ' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U 10/12/2003 i 01/10/1924 w REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) ] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] lQ Spousal Povedy Credit (date of death between 12-31-91 and 1-1-95) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11, Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~AME Debra K. Wallet FIRM NAME (If applicable) Law Offices ofDebra K. Wallet tELEPHONE NUMBER ?17/737-t300 LING ADDRESS 24 North 32nd Street Camp Hill, PA 17011 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) [] 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) None ' l' None None None 17,929.87 None None 1,707.00 1,797.10 12. Net Value of Estate (Line 8 minus Line 11) 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) (8) (11) (12) (13) (14) 17,929.87 3,504.10 14,425.77 14,425.77 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) x .00 (15) 16.Amount of Line 14 taxable at lineal rate 14,425.77 x .045 (16) 649.16 649.16 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. [] x .12 (17) x .15 (18) (19) >>. BE SURE TO ANSVVER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 230 Brian Dr. Enola STATE PA [ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 32.46 Total Credits (A + B + C) (1) 649.16 (2) 32.46 3. Interest/Penalty if applicable 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. (4) Check box on Page 1 Line 20 to request a refund 5. If Line I + 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. (SB) 0.00 616.70 616.70 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; .................................... L..J [~ c. retain a reversionary interest; or ................................................................................................................ I I d. receive the promise for life of either payments, benefits or care? ............................................................. D [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pequ~, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on ail information of wl~ch preparer has any knowledge. SIGNATURE OF PERSON RESPON~BLE FOR FILING RETURN SI~NA?URE ~F PERSON'RESPO~'~B't~E FOR ~LING RETURN ADDRESS 230 Brian Drive DATE P.O. Box 68 Enola, PA 17025 / //D~/ ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE Debra K. Wallet 24 North 32nd Street ~0i4~ ~ ~a4,O.4"' Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempta transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Swanger, Hannelore A. !FILE NUMBER ~ 21 03 00912 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 Omega Bank Checking Account #001058992 Presbyterian Homes refund Central PA Teamsters Pension Fund Personal property donated to nursing home VALUE AT DATE OF DEATH 14,504.77 3,311.10 114.00 0.00 TOTAL (Also enter on Line 5, Recapitulation) 17,929.87 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Swanger, Hannelore A. I FILE NUMBER 21 - 03 - 00912 Debts of decedent must be reported on Schedule I. ITEM ! NUMBER DESCRIPTION I AMOUNT FUNERAL EXPENSES: ~ Lewistown Monument 63.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Debra K. Wallet, Esq. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees State Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Postage, photocopies, etc. 1,500.00 114.00 30.00 TOTAL (Also enter on line 9, Recapitulation) 1,707.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Swanger, Halmelore A. FILE NUMBER i 21 - 03 - 00912 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Continuing Care (final pharmacy bill) E.P. Ambulance Carlisle Regional Medical Center Carlisle Pathology Assoc. Carlisle Digestive Metro Med. Services Graham Medical Clinic AMOUNT 1,488.66 87.00 11.97 7.89 24.08 150.00 27.50 TOTAL (Also enter on Line 10, Recapitulation) 1,797.10 REV-1513 EX+ (9-00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Swanger, Hannelore A. !FILE NUMBER ~ 21 - 03- 00912 NUMBER I. 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Robert L. Swanger 230 Brian Dr., PO Box 68, Enola, PA 17025 Douglas Swanger 221 Harvest Ln., Chambersburg, PA 17201 Lisa Farber 9 Whipoorwill Dr., Worcester, MA 01606 RELATIONSHIP TO DECEDENT i AMOUNT OR SHARE L - Do Not LisLTrustee(s) _ ! __OF ESTA~T Son 1/3 of residuary estate Son il/3 of residuary estate Daughter 1/3 of residuary estate !Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BE NG MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ,/ Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Swanger, Hannelore A. also known as , Deceased Robert L. Swanger No. 21 - 03 - 00912 Date of Death 10/12/2003 Social Security No. 164-30-5184 The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: I.D. No.: Address: O2a,,~.. tf .~. Debra K. Wallet 23989 24 North 32nd Street Camp Hill, PA 17011 Telephone: 717/737-1300 Personal Representative Robert L. Swange/~- Signature: Signature: Signature: Address: 230 Brian Drive P.O. Box 68 Enola, PA 17025 Telephone: (717) 732-3212 Dated: /-./0 - C) ~/ Personal Property Omega Bank Checking Account #001058992 Presbyterian Homes refund Central PA Teamsters Pension Fund Personal property donated to nursing home Total Personal Property 14,504.77 3,311.10 114.00 0.00 $17,929.87 (Attach additional sheets if necessary) Total Personal Property and Real Estate $17,929.87 e~ in IN THE ORPHANS' COURT DIVISION OF THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF HANNELORE A. SWANGER, DECEASED No. 2003-00912 APPROVAL OF ACCOUNT, WAIVER, RECEIPT, RELEASE, AND AGREEMENT OF INDEMNITY The circumstances leading up to the execution of this instrument are as follows: 1. 2. Hannelore A. Swanger died intestate on October 12, 2003. Letters of Administration were granted to Robert L. Swanger by the Registe~ of Ils of Cumberland County on November 3, 2003. 3. It is the desire of the Swanger heirs that the Estate be distributed without the mality of a court proceeding in order to save the expense, publicity, and delay incident to h court proceeding, and the Administrator is willing to make such distribution upon the ution of this instrument. 4. An account of the administration of the Estate of Hannelore A. Swanger has prepared by the Administrator. A copy is attached hereto as Exhibit A. 5. In consideration of the foregoing, each of the undersigned hereby: A. Represents and warrants that he/she has read and understands this · ument and that the facts set forth above are true and correct to the best of his/her Medge, information and belief; B. Declares that he/she has examined the attached account of the administration the Estate and the attached schedule of distribution; that he/she finds them to be true and -1- C* rect in all particulars; that he/she accepts and approves them as if they had been duly filed, lited, adjudicated and confirmed absolutely by the Orphans' Court Division of the Court df mmon Pleas of Cumberland County, and as if the amounts shown as distributable had been awarded to him/her; C. Waives the filing and auditing of the account of the administration of the te in the Orphans' Court Division of the Court of Common Pleas of Cumberland Count, ar agrees that the Orphans~ Court Division of' the Court of Common Pleas of Cumberland C, ~nty may by ~ts decree confirm the account and approve tb~: schedule of distribution; D. Requests the Administrator to make distribution of the principal and income ~ccordance with the schedule of distribution, and effective upon delivery to him/her of the at ounts sho~p as respectively distributable, acknowledges receipt of such property; E. Agrees to refund to the Administrator any' amount which ~nay at any time be d ermined to have been an erroneous distribution to him/her, regardless of the cause of sucl~ et oneous distribution, even if attributable to negligence, and agrees that any period for the li~ tation of actions ibr the collection of any erroneous distribution shall ~:ommence only at si l time as the Administrator shall have obtained actual knowledge of such erroneous di tribunon and that in no e~ent shall the period for collection of any erroneous distribution be I¢ s than two )e:~rs after the actual discovery thereof; 15. Absolutely and irrevocably remises, re~eases, quitclaims and forever charges Rober~ L. Swanger, individually and in his capacity as Administrator, from any and ai actions, suits, payments, accounts, reckonings, liabilitie% claims and demands relaUng in al / way to the administration of the Hanne!ore A. Swanger Estate; -2- G. Agrees to indemnify and hold harmless, to the extent of the funds received him/her hereunder, Robert L. Swanger, individually and in his capacity as Administrator~ m and against any and all claims, loss, liability or damage (including legal fees and costs in ci ~nection therewith) which he may suffer or to which he may be subjected by reason of his ai ninistration of the Estate, the settlement of his Administrator's account and the distributio~n oI the assets of the Estate without having the formal approval of the Orphans' Court Divisioa oi the Court of Common Pleas of Cumberland County, including, but not limited to, any la ~ility for any federal estate tax, Pennsylvania inheritance tax or any other death taxes, tO ~ther with interest and costs incidental thereto, relating in any way to the Estate; and H. Declares it to be his/her intention that this instrument, consisting of three p es, shall be governed by the law of Pennsylvania and shall be legally binding as an :ement under seal upon him/her and upon his/her heirs, executors, administrators and ,~ns. Executed on ,'X,'~,~'_. 2: ,2004. ,} ,4 .?<T"~ -~ '; .'l. /,", /. f -.(Seal) ROBERT)I~ SWA~GY~R FARBER (Seal) (Seal) BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA No. 2003-00912 FIRST AND FINAL ACCOUNT OF ROBERT L. SWANGER, Administrator For HANNELORE A. SWANGER ESTATE, Deceased te of Death: te of Administrator's Appointment: counting for the Period: October 12, 2003 November 3, 2003 November 3, 2003 to November 12, 2004 PURPOSE OF ACCOUNT: Robert L. Swanger, Administrator, offers this Account to uaint interested parties with the transactions that have occurred during his administratiom The Account also indicates the proposed distribution of the Estate. It is important that the Account be carefully examined. Requests for additional ~rmation or questions or objections can be discussed with: Debra K. Wallet, Esquire 24 N. 32nd Street Camp Hill, PA 17011 I.D. #23989 (717) 737-1300 EXHIB1TA SUMMARY OF ACCOUNT Current Page Value Fiduciary! AcquisitiOn Value R Ii B C )posed Distribution Beneficiaries INCIPAL :eipts ~s Disbursements ~ebts of Decedent uneral Expenses dministration Expenses ederal and State Taxes ees and Commissions ncipal Balance on Hand :OME fipts ome Balance on Hand ance Before Distributions mbined Balance on Hand 5 $5,401.80 2 3 $10,409.95 3 63.00 3 132.44 3 619.70 3 1,342.50 $17,929.87 12,567.59 $5,362.28 $39.52 39.52 $5,401.80 $5,401.80 RECEIPTS OF PRINCIPAL sets Listed in Inventory: v'alue as of Date of Death) h and Bank Deposits: :tega Bank Checking Account (#001058992) $14,504.77 ntral PA Teamsters Pension Fund 114.00 $14,618.77 ngible Personal Property: rsonal property donated to nursing home $0.00 funds: ~sbyterian Homes refund $3,311.10 }TAL ASSETS LISTED IN INVENTORY: $17,929.87 }TAL RECEIPTS OF PRINCIPAL: $17,929.87 2 DISBURSEMENTS OF PRINCIPAL ~ts of Decedent: mtinuing Care (final pharmacy bill) $1,488.66 P. Ambulance 87.00 xlisle Regional Medical Center 11.97 [rlisle Pathology Assoc. 7.89 ·lisle Digestive 24.08 ~tro Med. Services 150.00 'aham Medical Clinic 27.50 :partment of Public Welfare 8,612.85 (medical assistance lien) II $10,409.95 metal Expenses: vistown Monument $63.00 ministration Expenses: obate Fees ink Fee ~stage, photocopies, etc. ;erve for Filing of Account $99.00 1.00 17.44 15.00 $132.44 leral and State Taxes: Inheritance Tax ;erve for 2004 PA Fiduciary Tax $616.70 3.00 $619.70 and Commissions: ebra K. Wallet, Esq. - Attorney's fees $1,342.50 3 RECEIPTS OF INCOME erest rate Checking 03 Imerest 04 Interest and Savings Account 7.35 32.17 )TAL RECEIPTS OF INCOME: $39.52 4 PROPOSED DISTRIBUTION TO BENEFICIARIES Robert L. Swanger 230 Brian Drive P.O. Box 68 Enola, PA 17025 1,800.60 Douglas Swanger 221 Harvest Lane Chambersburg, PA 17201 1,800.60 Lisa Farber 9 Whipoorwill Drive Worcester, MA 01606 1,800.60 TAL PROPOSED DISTRIBUTION TO BENEFICIARIES: $5,401.80 BUREAU OF ZNDTVZDUAL TAXES ZNHERITAHCE TAX DIVZSTON DEPT. 180601 HARR/SBUR(;, PA 17118-0601 COHHONgEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX RE¥-15~i7 EX AFP DEBRA K gALLET DEBRA K gALLET LAg OFC 24 N $2ND ST CAHP HILL . . ' :~ C:~ DATE ,~'u- ESTATE OF DATE OF DEATH FILE NUHBER '04 F£8 27 71:0 OUNTY ACN 05-01-2004 SgANGER 10-12-1005 21 05-0912 CUHBERLAND 101 PA 17o1~tirr~ber:,~.~i~U Co., PA HANNELORE A Amount Remitted [ NAKE CHECK PAYABLE AND RENTT PAYHENT TO-' REGISTER OF gILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOgER PORTION FOR YOUR RECORDS -~ REV-15&7 EX AFP (01-03) NOTICE OF ]:NHERTTANCE TAX APPRAZSEHENT, ALLOgANCE OR DZSALLOgANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF SgANGER HANNELORE AFTLE NO. 21 0.3-0912 ACN 101 DATE 0.3-01-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERN/NG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership /nterest (Schedule C) ($) ~. Nortgages/Notes Receivable (Schedule D) (4) $. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Nortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return 17z929.87 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper port/on .00 of this fore with your tax payment. .0O (8) 1,707.00 15. 1~. NOTE: 1,797.10 (11) (12) Charitable/Governeental Bequests; Non-elected 9115 Trusts (Schedule J) (1:51 Net Value of Estate Subject to Tax (1 :If an assessment Has issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. 17,929.87 ASSESSHENT OF TAX: 15. Amount of L/ne 1~ at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of L/ne 1~ a~ Sibling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDZTS: PAYHENT RECE/PT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 01-12-2004 CD0054`32 `32.46 14,425.77 ZF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZTIONAL ZNTERESTo .00 14,425.77 18 and 19 w111 (15) .00 x O0 = .00 (16) 14,425.77 x 045= 649.16 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19): 649.16 ANOUNT PAID 616.70 TOTAL TAX CREBZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 649.16 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. IF TOTAL DUE IS REFLECTED AS A 'CRED[T' (CR), YOU NAY BE DU~*~ A REFUND. SEE REVERSE S/DE OF TH/S FORN FOR INSTRUCTIONS.) ~-/