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HomeMy WebLinkAbout07-02-13 REV-1500 EX (01-10' 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 260601 INHERITANCE TAX RETURN 2 1 1 2 0 1 1 4 0 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BE_LOW. Social Security Number Date of Death MMDDYYYY Date of Birth ' MIYIDDYYYY 1 0 1 6 2 0 1 2 1 1 0 4 1 9 3 5 Decedents Last Name Suffix Decedents First Name MI S W A'R T Z H A R 0 L D W (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI S W A R T Z P A U L I N E M Spouse's Social Security Number ' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW - O 1.Original Return 2.Supplemental Return 3.Remainder Return(date of death pnor to 12-13.82) 4.Um(ted Estate - 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12-12.82) © 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) - (Attach Copy of Trust) 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name - Daytime Telephone Numberr-� D O U G L A S G M I L L E R 7 1 7 T2o4 -9 `2' 3 3 rn REGISTEROF WILLS USE ONUYs stern ry mr- First line of address I R W I N & M c K N I G H T P C Second line of address tc t ' -❑ r- 6 0 W E S T P 0 M F R E T S T R E E T za "' ° ry 7n City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 Corraspondenrs e-mail address: Under penalties of duty,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is We,correct a complete.Declaration of preps r other than the personal representative Is based on all information of which preparer has any knoxledge. SIGNATURE O RSON R SPON F LING RET RN DATE 7 /3 ADDRESS 3465 TUSCARORA PATH LOYSVILLE PA 17047 SIGNATUT%P QPARERJyfHE ^ EPRESENiATNE ADDRES `n�� 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: HAROLD W • $W A R T Z RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 8 8 3 4 4 7 , 0 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages and Notes Receivable(Schedule D) .. . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 1 9 7 4 5 5 , 3 5 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 1 2 2 2 3 3 , 3 7 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 1 4 2 8 3 , 5 3 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 2 1 7 4 1 9 , 2 9 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 9 0 3 8 4 . 6 2 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 0 0 6 5 . 0 0 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 0 0 4 4 9 . 6 2 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 1 1 6 9 6 9 . 6 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. 5 0 0 0 0 . 0 0 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . . . . . . . . . . . . . . . . . . . . 14. 1 0 6 6 9 6 9 . 6 7 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ 3 6 5 3 8 0 . 0 9 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 7 0 1 5 8 9 . 5 8 16, 3 1 5 7 1 . 5 3 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . ❑ 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 3 1 5 7 1 . 5 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 12 01140 DECEDENTS NAME HAROLD W. SWARTZ STREETADDRESS 1399 SHUMAN DRIVE CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 31,571.53 2. Credits/Payments A.Prior Payments 28,500.00 B.Discount 1,578.58 Total Credits(A+B) (2) 30,078.58 3. Interest (3) 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. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,492.95 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; ...................................................................... ❑❑ a b. retain the right to designate who shall use the property transferred or its income; X c. retain a reversionary interest;or ................................................................................................ ❑ n d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X 2. If death occurred after December 12,1982,did decedent transfer properly within one year of death without receiving adequate consideration? ....................................................................................... ❑ ❑X 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. 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 is 3 percent[72 P.S.§9116(a)(1.1)(1)]. 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)].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. REV-1503 EX+(8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD W. SWARTZ 21 12 01140 All property jointly-owned with right of survivorship must he disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. INTEGRITY INVESTMENT SERVICES 8,439.33 EATON VANCE FUNDS#0103739314 TAX MANAGED GROWTH 2. INTEGRITY INVESTMENT SERVICES 17,250.79 EATON VANCE FUNDS#0103739314 TAX MANAGED VALUE 3. INTEGRITY INVESTMENT SERVICES 18,276.50 EATON VANCE FUNDS#0103739314 TAX MANAGED MULTI CAP GR 4. INTEGRITY INVESTMENT SERVICES 15,416.47 EATON VANCE FUNDS#0103739314 TAX MANAGED SMALL CAP 5. 7,995 SHARES OF PNC FINANCIAL SERVICES GROUP 482,898.00 7,995 X$60.40 =482,898.00 6. 101 SHARES OF PRUDENTIAL FINANCIAL 5,862.04 101 X$58.04= $5,862.04 7. EDWARD JONES 228,735.91 ACCOUNT#377-05229-14 8. 2768 SHARES OF FIRST COMMUNITY FINANCIAL CORP 106,568.00 2768 X $38.50 PER SHARES= $106,568.00 TOTAL(Also enter on line 2,Recapitulation) $ 883 447.04 (If more space is needed,insert additional sheets of the same size) REV-1508 EX+(11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT TURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: HAROLD W. SWARTZ 21 12 01140 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must he disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. FIRST NATIONAL BANK OF MIFFLINTOWN 50,070.14 CERTIFICATE OF DEPOSIT#4091112 2. FIRST NATIONAL BANK OF MIFFLINTOWN 54,236.78 INDIVIDUAL CHECKING ACCOUNT#1229491 3. FIRST NATIONAL BANK OF MIFFLINTOWN 5,333.35 INDIVIDUAL CHECKING ACCOUNT#6615017 4. RIVERVIEW BANK 50,084.45 CERTIFICATE OF DEPOSIT#3059330 5. F&M TRUST- MONEY MANGEMENT ACCOUNT#0007029861 2,936.76 6. PERSONAL PROPERTY 8,734.00 7. INTEGRITY INVESTMENT SERVICES 26,059.87 FOLIO IRA#MB3410900W BENEFICIARY: THE ESTATE OF HAROLD SWARTZ TOTAL(Also enter on Line 5,Recapitulation) $ 197 455.35 If more space is needed,insert additional sheets of paper of the same size REV-1509 EX-(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HAROLD W. SWARTZ 21 12 01140 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. PAULINE M. SWARTZ 1399 SHUMAN DRIVE SPOUSE CARLISLE, PA 17015 B. DAVID L. SWARTZ 3465 TUSCARORA PATH SON LOYSVILLE, PA 17047 c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST t. A. 04/2011 F&M TRUST 50,800.15 33.3333 16,933.37 CERTIFICATE OF DEPOSIT#172998351 2. a. 04/2006 1399 SHUMAN DRIVE, CARLISLE, PENNSYLVANIA 210,600.00 50. 105,300.00 TOTAL(Also enter on Line 6,Recapitulation) $ 122 233.37 If more space is needed,use addifional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD W. SWARTZ 21 12 01140 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. DESCRIPTION OF PROPERTY ITEM INCLUDETHE NAME OF THETRANSFEREE,THEIR RELATIONSHIPTO DECEDENT AND DATE OF DEATH % DECUS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST PFPPPDCA&.kT VALUE 1. INTEGRITY INVESTMENT SERVICES 1,638.92 100.00 1,638.92 SSgA IRA#1000783937 BENEFICIARY: PAULINE SWARTZ 2. INTEGRITY INVESTMENT SERVICES 5,607.18 100.00 5,607.18 WELLS II IRA#1000783937 BENEFICIARY: PAULINE SWARTZ 3. PRUDENTIAL ANNUITY SERVICES 7,037.43100.00 7,037.43 CONTRACT#95157377 BENEFICIARY- PAULINE SWARTZ TOTAL (Also enter on Line 7,Recapitulation) $ 14 283.53 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD W. SWARTZ 21 12 01140 Decedents debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. RONAN FUNERAL HOME 12,695.61 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) DAVID L. SWARTZ 35,000.00 Street Address city State ZIP Yeaqs)Commission Pak: 2. Attorney Fees: IRWIN & McKNIGHT, P.C. 36,500.00 3. Fam4 Exemption:(If decedenfs address is not the same as claimants,atlach explanation.) 3,500.00 Claimant PAULINE M. SWARTZ Street Address 1399 SHUMAN DRIVE C4 CARLISLE State PA ZIP 17015 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees: REGISTER OF WILLS 773.50 5 Acoountant Fees: 6. Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00 FINAL FIDUCIARY TAX RETURN 7. REGISTER OF WILLS- FILING FEE 30.00 8. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00 9. THE SENTINEL- ESTATE NOTICE 189.54 10. LARRY A. SWARTZ, AUCTIONEER-APPRAISAL ON PERSONAL PROPERTY 100.00 11. VITAL RECORDS-ADDITIONAL DEATH CERTIFICATES 73.00 12. REGISTER OF WILLS-SHORT CERTIFICATES 20.00 13. REPAIRS TO REAL ESTATE 300.00 14. LAWN CARE 752.97 TOTAL(Also enter on Line 9,Recapitulation) $ 90 384.62 If more space Is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES,&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HAROLD W. SWARTZ 21 12 01140 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. THORNWALD HOME- NURSING 4,561.70 2. DR. GEORGE BRANSUM -MEDICAL 24.84 3. MILLENNIUM PHARMACY-MEDICAL 500.76 4. CENTURYLINK-TELEPHONE 495.93 5. PPL- ELECTRIC 607.21 6. MONROE TOWNSHIP MUNICIPAL AUTHORITY-SEWER 850.00 7. SHIPLEY ENERGY- FUEL 1,308.16 8. MARY MURRAY, TAX COLLECTOR - REAL ESTATE TAXES 1,239.40 9. ERIE INSURANCE- HOMEOWNERS INSURANCE 477.00 TOTAL(Also enter on Une 10,Recapitulation) $ 10 065.00 If more space is needed,insert additional sheets of the same size. REV-1513 EX.(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HAROLD W. SWARTZ 21 12 01140 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. MARLIN L. HOVIS Lineal 5,000.00 4037 CLAIR MAR DRIVE DOVER, PA 17315 2. MICHAEL A. HOVIS Lineal 5,000.00 900 GOODYEAR ROAD GARDNERS, PA 17324 3. MARTIN F. HOVIS Lineal 5,000.00 422 PINE ROAD MT. HOLLY SPRINGS, PA 17065 4. DAVID L. SWARTZ Lineal 228,863.19 3465 TUSCARORA PATH 1/4TH REMAINDER LOYSVILLE, PA 17047 5. LARRY A. SWARTZ Lineal 228,863.19 232 N. HIGH STREET 1/4TH REMAINDER BIGLERVILLE, PA 17307 6. MARK H. SWARTZ Lineal 228,863.20 1183 YORK ROAD 1/4TH REMAINDER MECHANICSBURG, PA 17055 7. PAULINE M. SWARTZ Spousal 365,380.09 1399 SHUMAN DRIVE 1/4TH REMAINDER CARLISLE, PA 17015 JT ACCT/TRANSFERS ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. WESLEYAN CHURCH OF THE CROSS 50,000.00 TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 50 000.00 If more space is needed,use additional sheets of paper of the same size. , �o o r° �mv,_ C> G,O M 5i O , C5 D O LAST WILL AND TESTAMENT `., I,HAROLD W.SWARTZ,of Monroe Township,Cumberland County,Pennsylvania,being of sound and disposing mind and memory,do hereby make,publish and declare this to be my Last Will and Testament,hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my legally enforceable debts,funeral expenses,testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property)shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My personal representative shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give, devise and bequeath the sum of Five Thousand($5,000.00)Dollars unto each of my stepsons, MARLIN L. HOVIS, MICHAEL A. HOVIS and MARTIN F. HOVIS, absolutely. 3. 1 give, devise and bequeath the sum of Fifty Thousand ($50,000.00) Dollars unto THE WESLEYAN CHURCH OF THE CROSS of Carlisle, Pennsylvania, for its general uses and purposes, absolutely. 4. I give, devise and bequeath all the rest, residue and remainder of my estate, whether real, personal or mixed property,whether tangible or intangible,and wherever situated,in four(4)equal Page 1.of 4 Pages +jys H.W.S. shares,unto my sons,DAVID L. SWARTZ,LARRY A. SWARTZ and MARK H. SWARTZ,and my wife,PAULINE M. SWARTZ,absolutely. Provided,however,that the share of the said David L. Swartz shall be reduced by the un-reimbursed aggregate amount of certain funds advanced, credited or loaned to him by me during my lifetime,which amount stands at Eighty-Five Thousand ($85,000.00)Dollars as of this writing. To the extent that the share of the said David L.Swartz shall be reduced accordingly, the shares of the said Larry A. Swartz and Mark H. Swartz shall be increased, on a pro rata basis. 5. I nominate,constitute and appoint my son,DAVID L.SWARTZ,as Executor of my estate. In the event he shall be unable or unwilling to serve in such capacity,then I appoint my son,MARK H. SWARTZ, to act in such capacity. 6. I direct that my personal representative shall not be required to file a bond to secure the faithful performance of his duties in any jurisdiction. 7. I authorize and empower my personal representative, in his sole and absolute discretion,to purchase or otherwise acquire and retain any investments or any property of any nature which I own at my death;to sell,lease,pledge,mortgage,transfer,exchange,dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as he may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate;to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share;to employ agents,attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to cart' out any of these powers. In addition, I direct that my Page 2 of 4 Pages H.W.S. personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this 22nd day ofNovember, 2006. . U 151- _ (SEAL) Harold W. Swartz SIGNED,SEALED,PUBLISHED AND DECLARED bythe above-named Testator,as and for his Last Will and Testament,in the presence of us,who at his request,have hereunto subscribed our names as witnesses thereto, in the presence of the said Testator and of each other. 4 Page 3 of 4 Pages COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, HAROLD W. SWARTZ, Testator, 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 willingly;and that I signed it as my free and voluntary act for the purposes therein expressed. Harold W. Swartz ff/J Sworn or affirmed to and acknowledged before me by OLD W.SWARTZ,the Testator, this 22nd day of November,2006. Notary Public COMM OF PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA ) hCOUNTY OF CUMBERLAND : SS. ber tonor� M"ember Aasoolation o1 Notadss We, 2� r L -?—>Vorv+ and i`C'v of as �U7-b)vc>,-n the witnesses whose Aames are signed to the attached or foregoing instrument,being duly qualified according to law, do depose and say that we were present and saw HAROLD W. SWARTZ, the Testator,sign and execute the instrument as his Last Will;that the Testator signed willingly and that the Testator executed it as his free and voluntary act for the purposes therein expressed;that each of us, in the hearing and sight of the Testator,signed the Will as witnesses;and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Address -2100 Lon R s 4 ao a[ 1-701-3 _ d ess 2100 I-M, 6z 2d. 6adisle , Q 17013 Sworn or affirmed to and subscribed before me this day of No tuber, 2006. d� d b trv� Notary Pu lic COMMONWEALTH OF PENNSYLVANIA C.Noffioe-Estate Ptanning110568.2h.will.dac Notarialseal Sharon E.Bloom,Notary ftle Page 4 Of 4 Pages North MiftarnTwp.,a,mbarlandCounty g g My Commis IsionE*hasAug.5,20to Member.Perms ants Association of Nebular 22C East Roseville Road q Lancaster, PA 17601 Tr1�T�7�7�'nGmTr�PlY � " � 1-800- 89-8180 Jl�l�lll�� X111 1��/N 1�!!!1 1�1 X111 �Y1( 1-800-789-7526 INVESTMENT SERVICES OCT 2,7 2012 FAX (717)560-6391 TRWI618�WKNIRT LAW OF;ICES October 26, 2012 Douglas Miller, Esq. 60 West Pomfret Street Carlisle, PA 17013 RE: Harold Swartz Dear Mr. Miller, Below please find the date of death values, October 16, 2012, for Mr. Swartz' accounts. Investment Account# Value > / Folio IRA MB341090OW $26,059.87 '- 0 %SSgA IRA 1000783937 $1,638.92 4 Wells II IRA 1000783937 $5,607.1 - Eaton Vance Funds Tax Managed Growth 0103739314 $8,439.33 Tax Managed Value 0103739314 $17,250.79 Tax Managed Multi Cap Gr 0103739314 $18,276.50 Tax Managed Small Cap 0103739314 $15,416.47 Total $92,689.06 I will follow up with the claim information and instructions for liquidating the accounts. Please call if you have any questions. Sincerely, " Jo R. McCoy, II Registered Principal Securities America, Inc. Cc: David Swartz Securities offered through Securities America,Inc.,Member FRQWSIPC,John McCoy,Registered Principal. Advisory services offered through Securities America Advisors,John McCoy,Investment Advisor Representative. Integrity Investment Services and the Securities America companies are not affiliated. CD II I§■§■g|■■$ ƒ z \ L\ - ( . 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K,Karen SOW NO Mail 2 My YI Yalml Sear& SearcWbWeb HOME INVESTING NEWS PERSONAL FINANCE MY PORTMUOS EXCLUSAA:S ELECTION 2012 II Get Quotas ' Finance Search Wed,Nov 7.2012.239pm EST-US Markets close in 1 hr and 21 mini Dow 42.19%Nesdaq 42.43% E+.'TRADE' OPEN.M ACC0tINr r„„„nwvra+ao PNC PNC Financial Services Group Inc.(PNC) -NYSE Add to Pomolio Uka 1 303 56.9242.16(3.66%) 2:39PM EST-Nasdaq Real Time Price Historical Prices Get Historical Prices tor:F GO . - - - - AdCholees Set Data Range r.,Daly StM Date: Oct 16 012 :Eg.Jan 1,2010 n weekly :owe: Oct FT-1 012 _ (7:Monthly q Dividends Only �GgtPrides First i Previous I Need I lest Prices Date Open High Low Close Wlume Adj Close' Oct 16,2012 61.30 61.60 59.94 60.40 10.576.300 60.40 ' •Case Price odysacl for dividends and splits. Upgrade First I Previous I NG]I Lost to the faster, safer Firefox. Download to Spreadsheet Cunmry in USD. 1 Optimized for Yahoo! r f E I � f Co,,r0iV ol2 Yohoo!M M dpa nserve4.RMry policy-Aada Ow Ads-Terns W Senke-Cop ripNP Potcy•send Feemack.Yahool-ARC News Network Were are real-thns for NASDAQ NYSE,and NYSE MKT.See also delay times for other rechanges Al inorrreaen provided'as Is'for Informational purposes only,not intended for"dng p+Poses M advoe,'Z!M Y~nor any of independent providers is kale for any iNarmmiprgl errors,irconpaleness,or delays,or for arty actions taken in rekance on inacrmauen eonwined herein,By accessing the YWgol site,you agree not to redisMiWle pn intprmWian found therein RewTime continuous saeamYg W Wes ere indeek through w prerNun service.Yw may Wm streanrg quxec w or off Fundanantal conpaly dale provided by Capital 10.Histonce chat data and daily Wdates provided by Conmodity Systems,Inc.lest.International Nsbricai dirt date,daily updates,font summary, hmel pedprnlarlca,dividend data snd Mornilgsler Indml dent provided by Morningstar,Inc. 1 of I 1]/7/2012 2:40 PM PrudenW �omputershare + Camputershare ✓= PO Box 43033 Providence,111 02940-3033 Miles SIMON IMPORTANT TAX RETURN DOCUMENT ENCLOSED Within USA,US territories 6 Canada 600 305 9404 GOES— Outside USA,US territories&Canada 732 512 3762 00000010771119 771119 www.computershare.comfinvestor Mile Recipient i= HAROLD W SWARTZ 3465 TUCARORA PATH LOYSVILLE PA 17047 io Holder Account Number C0020417382 I N D ;_ II � IIIuIIIIIIIIIIII)IIIIIIIIII�IIIIIIIIII I�IIIIIIIII III Record Date Nov 22 2011 Check Number 0013278646 SSNITIN Certified Yes 001CS0107D0MLNGEQS_P01 PRU.031a30_114/771119/]71119/i Prudential Financial, Inc. - Combined Dividend Payment 12011 Tax Form 1099-DIV Corrected(d checked) Account Number C0020417382 Form 1099-DIV-Dividends and Distributions 2011 Copy B-For Recipient Payees Fe er l I ending in 703180 Payers Federal ID No. 22.3703798 This Is importam taxinfemmnon and Is being furnished to the Internal Revemle Service. If you am required m file a remm,a neolkence OMB No. 1545.0110 permlty,w oelersanclion may be imposed m you 0thls Income Is taxable and 81e IRS determines Mat It has nm been repeated. Department come Treasury.imsmal Reoemm Sandra Recipient HAROLD W SWARTZ 3465 TUCARORA PATH LOYSVILLE PA 17047 La Total Ordinary 11, Qualified s Nonlivldend 4 FEDERALINCOME 6 Foreign Tex 7 Foregn Country s Cash Uquida$onl Dividends($) Dividends($)I DishibuNOns($) TAX WITHHELD($) 1 Paid($) 1 or I Possession Dw.($) Payer's Details 146.45 146.45 0.00 0.00 0.00 PRUDENTIAL FINANCIAL INC C/O COMPUTERSHARE P.O.BOX 43010 PROVIDENCE RI 02940-3010 Form 1099-DIV (Keep for your records) Dividend Confirmation Payment Date Class Description Participating Dividend Gross Deduction Deduction Net Shares/Units I Rate I Dividend($) I Amount($) Type Dividend($) 16 Dec 2011 COMMON 101 $1.45000 146.45 0.00 NIA 146.45 Year-To-Date Paid 146.45 0.00 146.45 4 6 U T X � �1 (p �' P R U + 002C570004 OORXOA-PP(F2) y ' PRU Historical Prices I Prudential Financial,Inc.Comm Stock-Yahoo... http://finance.yahoo.com/q/hp?s=PRU&a=09&b=16&c=2012&d=09&... Hi,Karen Sign Out Help Mail My Y! Yahoo, Search Search Web j HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES ELECTION 2012 Get Quolles- Finance Search Wed,Nov 7,2012,2'23pm EST-US Markets close in t M and 37 mire Dow 41.94%Nasdaq 42.20% .� TRADE7a FRE E 60 GAYS birlee,neolron LLO Prudential Financial,Inc.(PRU) -NYSE Adtl to Portfolio Like 55.99 42.04(3.52%) 2:22PM EST-Nasdaq Real Time Price Historical Prices Get Historical Prices for: _GO AdChoices Set Date Range (s,Daily Start Ber Oct 16 IFT12 Eg.Jan 1,2010 CWeekly End Bel Oct 16 x112_ Q Monthly O Dividends Only Pi lHriceS„ First I Previous I Next I Last Prices Date Open High Low Close Volume Adj Close' Oct 16,2012 57.07 56.72 56.99 58.04 4,293,600 58.04 Close price adjusted for divideri and splits. First I Previous I Next I Last iDownload to Spreadsheet Currency in USD. Coiol®1012 Yahoo!Inc,4 rights reserved.Privery Policy-Nebo!our Ads-Terms of Service-CoPpighti Policy-send Feedback-Yahoo!-ABC News Network Quotes are real-time for NASDAQ NYSE,and NYSE MKT See also delay times for Cher exchanges.All information brooded"as i5'for informational purposes only,not intended for trailing purposes or ad....Neither Yahoo!nor any of independent proHders is liable for any informational errors,incompleteness,or delays,or for any actions taken in reliance on information contained herein By accessing the Yahoo site,you agree not to redistribute the information found therein.Real-Time continuous streaming quotas are available through our premium service.You may hum streaming quotes on or o0 Fundamental company data provided by Capital IQ Historical chart data and daily updates promded by Commotlily Systems,Inc.(CSI) International historical chart data daily updates,fund summary, fund performance,dividend data and Mommgstar Index data prci by Morningstar,Inc. 1 of 1 11/7/2012 2:23 PM j 0 N N m to O O N O N to [C N U 0 CD T m U C0 3 T N ER N Lo N m a m ' m o ssa a is 3 am Xa v oo=o 69. t= N 3L Q v `o U) •> U w'5 C M j CV w WL > _m dm'p z w 3 ~' a� mm ION% LL L U al 3 U V .m Ta'(3 O _ B1 oc oE � > aEa°� w W "' C O C y} E3p �i CL$ n n o E ETOO E T Q w Q L Y 3 N U W Z ON mU= T l U p O r_ m M - m zo- o m a) 0 N NY o ' ai �OCT C6 C\r 0=T U l O F a) N: C8 3 p o ° ' `°o m vs � F- E v fA O N al O =$ W O M O 3 a) d U O O >, C C .O � I p •�yoC ^ ❑- a N R > ° N O 0 WC- m N O O 3 X m M O > o -2 a) E m a = - E �- N 0 mm EL- C) E -° mv `I cai23cd `m s r ca t v W � N 0 in 0 N L mm, E m2 ma v3v ON0) O0 C � - ID o n v C rL >`« a s f� V 7 o ? 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M i N y L iC a) •o° U a c > m is N y � TC Erma N yQCo NNN .a Nc0 0maE c n m mom aC Q C 3cl = ow0 7 ° o m0:5a G � r N '_' 3 EU•1 u m 9 T V O� 4t 3 H L m O j C O C C d o o cq c T m e c E V 5 > E0 E 7V Q � amm ocr . �S o di C 30 E o y m U m d m c 3° ou o E a m a awe a 5.__ Q . Ev° F Ofmw7lntown PO BOX 96 MIFFLINTOWN PA 17059 RESPONSE TO ACCOUNT INQUIRY AMENDED RESPONSE TO: IRWIN& MCKNIGHT, P.C. DECEDENT: HAROLD W SWARTZ DATE OF DEATH: 10/16/2012 SOCIAL SECURITY#: 192-32-3160 We held accounts in which this decedent had an interest at the time of his/her death as follows: ACCOUNT OWNER(S): : HAROLD W SWARTZ Type of Account : CERTIFICATE OF DEPOSIT Account#: 4091112 Principal Balance at D.O.D: $ 50,000.00 Interest Rate: 3.2000% Original Opening Date: 12/31/2004 Interest to DOD: $ 70.14 ACCOUNT OWNER(S): : HAROLD W SWARTZ Type of Account: INDIVIDUAL CHECKING Account#: 1229491 Principal Balance at D.O.D: $ 54,236.78 Interest Rate: 0.1000% Original Opening Date: 09/23/2008 Interest to D.O.D: $1.66 ACCOUNT OWNER(S): HAROLD W SWARTZ Type of Account: INDIVIDUAL CHECKING Account#: 6615017 Principal Balance at D.O.D: $ 5333.35 Interest Rate: 0.3000% Original Opening Date: 09/15/2009 Interest to D.O.D: $ 10.98 Penalty is waived on withdrawal of decedent's fund before maturity: Yes No Safe Deposit Box: Yes No First Community Financial Corp. stock or other securities: Qyjs> No �tq4,? -@/SL) Trust Dept. Accounts: Yes No 113�sol Authorized ignature/Title_� Date RIVERVIEW BANK AND ITS OPERATING DIVISIONS 200 Front Street,PO Box B,Marysville,PA 170S3 www.riverviewbankpa.com it 1(s'� yj(s L.. NOV 'ZU'h'i October 31,2012 f`' � �` 't'" Law Offices of Irwin&McKnight, PC RE: Harold W Swartz IPA,! Tls 1 `: g "Apt,;;.r;�;;c West Pomfret Professional Building DOD: 10/16/2012 60 West Pomfret Street Carlisle PA 17013 Account Number(s) 3059330 Type of Account Certificate of Deposit Date Opened January 3, 1998 Principal Balance at date of death $50,000.00 Interest Rate 4.4000% Accrued Interest not disbursed as of date of death $84.45 Maturity Date January 3,2013 Primary Owner of Account Harold W Swartz Name of Joint Owner(s), if any NA Beneficiary, if any N/A Date Joint Ownership was Established NA If within I year of death of Decedent could prior Account Be traced into a prior Joint Account in existence over 1 year prior to death of Decedent N/A N/A N/A Safe Deposit Box(s)and Location By: OL Jeanette K. Towsey, Assistant O rations Manager Halifax Bank Marysville Bank 300 Market Street 200 Front Street PO Box PO Box HR/f BQIt�C Halifax,PA 17032 arysville : Marysville,PA 17053 ' www.halifaxbankpa.com www.marysvillebankpa.com Appraisal Report Of Personal Property ESTATE OF Harold W. Swartz, deceased 1399 Shuman Dr Carlisle, PA 17015 Y - r= for: David Swartz, Executor 3465 Tuscarora Path Loysville, PA 17047 As of: October 16, 2012 (D O D) By: Larry A. Swartz " h Auctioneer 232 N High St, Aville Biglerville, PA 17307 717-677-0831 F Page 2 Appraisal Certificate 1 hereby certify, that upon request for valuation of the personal property of the Estate of Harold W. Swartz, deceased, 1399 Shuman Dr., Carlisle PA 17015, by David Swartz, Executor, 3465 Tuscarora Path, Loysville PA 17047, 1 have personally and physically inspected the following listed personal property for the purpose of appraising and reporting the FAIR MARKET VALUE, as of October 16, 2012 (D O D). Date of inspection being October 27, 2012. The information and values contained in this report are based upon my experience as an auctioneer, and other reliable sources. The personal property was found to be in GOOD condition, unless otherwise noted. Values are reported piece by piece, and as a whole. All values reported have been determined with consideration to condition of item, market conditions, and saleability factors. APPRAISAL SUMMARY It is my opinion, that as of October 27, 2012, the FAIR MARKET VALUE of the listed personal property is: $8,734 Signed, Larry A. Swartz Auctioneer PA license AU5624 This is not the appraisal report. The report must be read in its entirety Page 3 DEFINITIONS AS USED IN THIS REPORT APPRAISAL An opinion or estimate of value based on relevant and factual data, as of a given date, and usually in writing. VALUE Present worth of future benefits FAIR MARKET VALUE A dollar figure (determined by historical data and current market conditions) at which the property would change hands between a willing buyer and a willing seller, neither being under compulsion to buy nor the compulsion to sell, and both having reasonable knowledge of relevant facts of the property. VALUATION DATE October 16, 2012 (D O D) INSPECTION DATE October 27, 2012 Page 4 MARKET CONDITIONS- Household items continue to remain soft in value. Collectables attract interest, but are well below original retail value. Antique prices are steady, but no longer command a premium. SOURCES OF VERIFICATIONS: 1. Internet Research 2. Carl Ocker, Auctioneer Kenny's Auction 3. Bob Flickinger, Auctioneer 4. Charlene Caple, Auctioneer and Appraiser, HACC Instructor, Auctioneering 5. Kelley Blue Book Page 5 PERSONAL PROPERTY — SWARTZ APPLIANCES: Amana chest freezer 85.00 Microwave, counter top model 10.00 GARAGE/OUTDOORSITOOLS: Simplicity riding lawn mower 350.00 Troybilt push mower 50.00 Wheelbarrow 30.00 Lawn cart and grass sweepers 35.00 Air compressor 45.00 Bench grinder 17.00 Wooden and metal ladders 25.00 Assorted hand tools 200.00 Garden tools: shovel, rake, hoe, etc 50.00 Dewalt radial arm saw 65.00 Metal shelving, unassembled 20.00 Bench vise 15.00 Misc. hardware and fasteners 35.00 Lard cans 10.00 Milk can, drop handle 15.00 Kerosene heater 20.00 Wooden jar box 30.00 Shop vac 30.00 VEHICLES: 2002 Chevrolet Blazer 65,000 miles 5,600.00 Page 6 FURNITURE: Master bedroom set, Full size 150.00 Single beds with matching night stand 100.00 Kneehole desk (2) 100.00 Cedar Wardrobe - 60.00 Washstands-refinished (2) 100.00 Cradle 25.00 4 legged wooden stand 20.00 Slant top desk 60.00 Small dresser 20.00 Bookcases, wooden (2) 30.00 Wooden School desks (2) 30.00 Children's wooden table & chairs 15.00 Clothestree 5.00 Hurricane lamp, electric 20.00 Folding table 5.00 Empire Chest 40.00 Kitchen table and chairs 35.00 Magazine stand 10.00 End tables with lamps 12.00 Microwave stand 8.00 Dehumidifer 15.00 Office chairs (2) 25.00 COLLECTIBLES: Dough box with lid 50.00 Singer sewing machine, treadle 25.00 Empire buffet 80.00 Wagon seat 40.00 Wooden chairs 6 50.00 Nail bin 45.00 Drop leaf table 100.00 Blanket chests (2) 75.00 Chicken feeders 15.00 Pedal tractor 95.00 Glassware, misc 50.00 Page 7 Ice cream freezer, hand crank 75.00 Dry sink 150.00 Butter churns (2) 100.00 Crocks 50.00 Pitcher bowl set 20.00 Nail keg 35.00 Griswald waffle maker & skillets 30.00 Nippon sugar creamer set 15.00 Leflon Christmas pieces 12.00 TOTAL $8,734.00 a a Page 8 Assumptions and Limiting Conditions FAIR MARKET VALUE The term"Fair Market Value"as used in this report is defined as follows: The highest price estimated in terms of money which the property will bring in a competitive and open market under all conditions requisite to a fair sale, with the buyer and seller each acting prudently and knowledgeably, and assuming the price is not affected by undue stimulus. This appraisal is based upon the following assumptions, limitations, and conditions: 1. The information contained in this report is gathered from sources considered reliable and from personal examination and research of authenticity and that comparable sales and/or auction prices were available and dependable. 2. No responsibility is assumed for matters legal in nature, including but not limited to: representation of others of value, authenticity, condition, origin, or provenance of an item appraised. 3. The appraiser assumes that a normal and careful examination of the property was sufficient to determine its quality and condition and that no extraordinary examination procedures would be utilized unless specifically requested and the expenditure of funds therefore authorized. A. Court Attendance—The appraiser's court attendance and giving of expert testimony are not included as part of this report. THE UNDERSIGNED HEREBY CERTIFIES: 1. That, to the best of my knowledge and belief all statements and information included in this appraisal are true and based upon objective findings and that no pertinent information has been knowingly withheld or deleted in this report. 2. That neither the employment to make this appraisal nor compensation for doing so is contingent upon the value of the property. Even though it is the firm belief of the appraiser that the information furnished in this appraisal report and the conclusions drawn from this information are true and correct, they are not guaranteed. RESPECTFULLY SUBMITTED, LARRY SWARTZ, AUCTIONEER ........... mthstonbescm November 7, 2012 Irwin & McKnight, P.C. West Pomfret Professional Building 60 West Pomfret St. Carlisle, PA 17013-3222 RE: Harold W. Swartz To Whom It May Concern: In reference to the above customer, our records show the enclosed information to be accurate as of the date of decedents death. If I may be of any further assistance, please contact me. Sincerely, Brenda Hahn Deposit Operations Clerk 717-261-3668 717-264-6116 888-264-6116 P.O.Box 6010 Chambef.sburg,PA 17201-6010 KNOW 'F!�N'A N c. FA.OM PEOPLE .-OU''. / 00 | ( ! � � ( k / 00 0 2 \� | § § | \ ) § §§ � § 2| \ \ sr \| P. I; ® \ ( \(\\K � e , ! | ! \ m % � | Property Mapper i � :.p "� F� r P.6oci,Ht>n \:./Canb=ihreCeviI7,FP. _ — Off ��� io km features selerked: i �t�� ,ifi �-�� 1399 SHUP1AiV DRIVE � 1 �'"' PIiJ:22-1U-G640-O�OC ���111 Ueedboo!;:CNzi3-OUE:2o Owr2r:SWAl;IZ,HAkO!G W B PtA!4I @E Pti 1399 SHU��IAN DRIVE Land Use Code: 101 g PripedY iYpe:k PIiY:?2-10-064D-0?OC �*� Acreage:U.53 Deedbook:UO2i4-U0826 Square Feet: 1566 Droner:SWA.°.T%,HAF:DLD W£: TaxaL'L Stat�.is,T PAULifdE hi Clean&Green Status: Land Use Cade: 101 Land Assessed ltaAie :554UU PropedY TYpe:k 4creaoe:0.53 ���jjj er � Square feet 1566 �� i axable Status:T NI � Clean&Green Status: � Land Assessed Value*;55?00 Buildirna.Assessedvalue a': 155200 Total Assassed Value S:21U600 Sale Price is 195000 Sale Date:Rion Apr 24 2006 06:00:00 PM. http://gis.ccpa.net/PropertyMapper/ Prudential Annuities \ A Business of Prudential Financict Inc. Aim Prudential P.O.Box 7960 � 7�A6Aij Phdaddplik PA 19176 (888)788-2888 January 4,2013 IRWIN&MCKNIGHT PC Contract Owner:Harold W. Swartz ATTN:DOUGLAS G MILLER Cunlydul Number: 95157377 WEST POMFRET PROFESSIONAL BUILDING 60 WEST POMFRET STREET CARLISLE PA 17013-3222 VIA FACSMMIE(717)249-6354 Dear Mr.Miller: I am responding to your recent correspondence dated January 4,2013 wherein you requested the date of death contract fund value on the above decedent's annuity. Thank you for providing us with the requested information. As of October 16, 2012,Mr.Swartz's date of death, the contract fund value ey • ed$7,037.43. I trust you find this information helpful. If you have questions,please contact our Annuity Service Center at (888)778-2888. Representatives are available to assist you Monday through Thursday between 8:00 a.m. and 7:00 p.m., and Friday between 8:00 am.and 6:00 p.m.Eastern Time. Sincerely, ,boy Wpsen6Cum Joy Rosenblum Customer Service Representative Fixed aid variable aeni Ids are issued by Prudential Annuities Ille.4ssman¢Corporation Annuities are distributed by Prudential Annuities Distributor,Inc.Botb are hudential Financial companis loeamd in Shelton,CI'and each is wkly responsible for its own}menial condition and ceNravial nMigatinns. Ronan Funeral Home 255 York Road Carlisle, PA 17013 Tel: 717-258-9863 Fax: 717-241-4041 Lynn A. Ronan, Funeral Director Sunday,October 21,2012 Mr.David Swartz 3465 Tuscarora Path Loysville, PA 17047 Dear David, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found our services,so far,to be of the highest standards that we always try to achieve. The following is a summary of the service charges as previously explained and provided in written form on the services for: HAROLD W.SWARTZ PROFESSIONAL SERVICES Basic service of funeral director and staff $ 4,630.00 Embalming $Incl. Dressing, Casketingg and Cosmetology $Incl. Other Preparation o-f'Body $Incl. Total Funeral Service Selected TOTAL PROFESSIONAL SERVICES $4,630.00 Use of Facilities& Staff for Visitation $Incl. Use of Facilities&Staff for Ceremony at Funeral Home $Incl. Use of Staff&Equipment for Graveside Service $Incl. Transfer of Remains to Funeral Home $Incl. Hearse/Funeral Coach $Incl. Flower Vehicle $Incl. Flower/Lead Car $Incl. OTHER MERCHANDISE SELECTED Casket: Jamison Maple $3,985.00 Outer Burial Container $1,445.00 Memorial Package Incl TOTAL OTHER MERCHANDISE SELECTED $5,430.00 CASH ADVANCES Grave Opening/Closing Charge $ 1800.00 Certified Copies of Death Certificate $ 120.00 Clergy Honorarium $ 100.00 Organist $ 75.00 Newspaper Notice Sentinel $ 113.04 Newspaper Notice Patriot-News $ 215.57 Flowers $ 212.00 CASHADVANCETOTAL $2,635.61 TOTAL OF SERVICES $12,695.61 BALANCEDUE $12,695.61 If there are any questions.or concerns that remain unanswered,please call me. Sin ely,ARonan 1 I Funeral Director "V� Page 9 LARRY A. SWARTZ AUCTIONEER 232 N. HIGH ST BIGLERVILLE, PA 17307 (717) 677-0831 Billing Statement October 31, 2012 David Swartz, Executor Estate of Harold W. Swartz 3465 Tuscarora Path Loysville, PA 17047 Appraisal Fee: $100.00 Personal property: Estate of Harold W. Swartz, deceased 1399 Shuman Drive Carlisle, PA 17015 Includes: personal inspection, research, and consultations as of October 31, 2012. Thank you, Larry A. Swartz Auctioneer .w...+.�.+vr.u�. +.w�.y. uuya.i,www.v uxw.mn.�wwrvncauyn ccciy�aapX VitalChek Order Receipt Pfint Purchase Date: Friday, February 08, 2013 Payment Method: Visa XXXX XXXX XXXX 8545 Agency: Pennsylvania Vital Records Shift to: Marcus McKnight 60 W Pomfret Street Carlisle, PA 17013 Shipping Method: UPS Air Estimated Processing Time: 20 -25 business days Order Number: 33012800 Pin: 348828 Item Record Ordered Qty I Price Extra Copies Total 1 Death: Harold W. Swartz 5 $9.00 $36.00 $45.00 Agency Expedite Fee: $0.00 Processing: $10.00 Shipping: $18.00 Tax: $0.00 Total: $73.00 Estimated Processing Time: Estimated processing time may vary according to the resources and workloads of the agency. VitalChek has no control over these variations or the amount of time an agency requires to process an order. For these reasons, we do not guarantee processing times. Shipping is not included in processing times. Order Status Information: Check the status of your order at any time by clicking on the'My Order'tab at www.vitalchek.com, or by calling 866-203-2777 for automated order status information. Please be advised that if the order has already been transmitted to the government agency, we will not be able to cancel or make changes to the order. If you have any additional questions or would like to e-mail VitalChek about this order, please visit httos:t itlita[Chek-solLtions.custWp.com Shipping Information: If your order•is being shipped via an express service, you may receive a tracking number by e-mail once the order is processed and in transit. You may also be required to sign for the delivery of your certificate. Now that You've ordered your most important identity document, click here to protect it. F of 2 2!812013 11:09 AM STATEMENT 442 Walnut Home Statement Date: 12/01/2012 442 Wal Bottom Road . Carlisle, PA 17013 Due Date: 12/26/2012 _ Telephone: (717) 249-4118 Amount Enclosed $ Amount Due: $ 4,561.70 Account #: 1207 RE: Harold W Swartz Dave Swartz 3465 Tuscarora Path Loysville, PA 17047 Pte' nK s Y r3 p a !� '�a i want 4: �kiROte =,Cha' es pa meets e ..Bala'nces Balance B/F 4,561.70 4,561.70 Current 31-60 Days 61-90 Days Over 90 Days Amount Due .00 4,561.70 .00 .00 4,561.70:', Payments MUST be received BY the 25th of each month. The staff of Thornwald Home wishes you a most blessed Christmas Statement Date: 12/01/2012 holiday and joyous New Year! _ Due Date: 12/26/2012 Harold W Swartz- Account #: 1207 Thornwald Home 442 Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118