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Home My WebLink About10-06-06 IREV-150lJEX + (6-00) . uJ ~ :.::$1/) UQ:::': WILU ~OO UQ::...I ILm IL oCt OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER II 06 COUNTY CODE YEAR SOCIAL SECURITY NUMBER I- Z W o W o W o --IDECEOENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ! Swiler, Charles P 'DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 03-09-2006 08-24-1956 : (IF APPLICABLE)-~S-URVIV'NG--SP'OUSE'S NAME ( LAST. FIRST AND M1DDLE INITIAL) 184-48-8643 0277 NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o D : )C_, 1. Original Return o 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) r-l 6. Decedent Died Testate (Attach 0 7. Decedent Maintained a Living Trust (Attach ~-, copy of Will) copy of Trust) iJ 9. Litigation Proceeds Received 0 10. Spousal Pove~ Credit (date of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0) L_ 12-31-91 and 1-1-95) .THIS.SECtl()N.'Ml)sTBECOMeEEr~D;~L':~PRri~~PPN6g~c~:~'RQ';;~ONfIQ~Nn~p;f8:t~!oR~TI:()~il~!()l)~p;il~;P'\~Ecx~Q;im()fi;;/ii, NAME COMPLETE MAILING ADDRESS Diane ~___~_~~~!~_f,_ Esq uire FIRM NAME (If applicable) 4. Limited Estate ~ z uJ o z o l1. rn w Q:: Q:: o U TELEPHONE NUMBER (717) 7 ~!_~~~ ~O__.___. 3. Remainder Return (date of death prior to 12-13-82) (1 ) (2) (3) (4) (5) (6) (7) None None None .' None 66,433.75 None 35,972.35 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o i= ~ :::l .... ii: < o W 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [J Separate Billing Requested 7 . Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) [] Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9.Funeral Expenses & Administrative Costs (Schedule H) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 3448 Trindle Road Camp Hill, PA 17011 (9) (10) 4,418.48 267.97 OFFICIAL USE ONLY (11 ) (12) (13) (14) 15.Amount of Line 14 taxable at the spousal tax rate, 97,719.65 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 0 .045 (16) i= 16.Amount of Line 14 taxable at lineal rate 0.00 x ~ :::l Q" 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :! 0 u 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) >< < I- 19. Tax Due (19) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 . Total Deductions (total Lines 9 & 10) 13. Charitable and Governmental Bequests/See 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) l'"'-.) c:::l C:;:) CT\ o C? -J I Q'. :::TJ ;-71 C) C~) XJ '.=-~ f-n ,.: f==:J . <::=2 '-;-j cS fT1 12. Net Value of Estate (Line 8 minus Line 11) :102,406'(10 4,686.45 97,719.65 0.00 97,719.65 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 0.00 0.00 0.00 0.00 >> BE'SURE T()ANSwER'A~LQUESTI6NS';()NREVERSE:Slpe:~pt~E(:ffEc::i<'MATH<:<' Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00; Rev-1508 Ex+ (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA TE OF Swiler, Charles P FILE NUMBER 21-06-0277 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Amtrak - Vacation Pay 2.763.68 2 Blue Chip Federal Credit Union - Share Account 105.82 3 Blue Chip Federal Credit Union - Certificate of Deposit 32.502.38 4 Blue Chip Federal Credit Union - Savings Account 5.00 5 Commerce Bank - Balance in checking account 3.960.50 6 IRA 17,016.72 7 1999 Toyota Pickup Truck 9.000.00 8 Amtrak - Paycheck 560.00 9 Amtrak - Paycheck 519.65 TOTAL (Also enter on Line 5, Recapitulation) 66.433.75 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151.EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Swiler, Charles P Debts of decedent must be reported on Schedule I. FILE NUMBER 21-06-0277 ESTATE OF ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 3,244.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Diane G Radcliff, Esquire 710.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 84.00 5. Accountant's Fees 301.54 6. Tax Return Preparer's Fees 7. Other Administrative Costs 78.44 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 4,418.48 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) . Rev-150Z EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Swiler, Charles P FILE NUMBER 21-06-0277 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Myers-Harner Funeral Home, Inc. - Funeral Bill 3.244.50 Subtotal 3.244.50 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule H-A (Rev. 6-98) .Rev.1502.EX+ (6-98) '* SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Swiler, Charles P FILE NUMBER 21-06-0277 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Rahal Toyota - Automobile Inspection 78.44 Subtotal 78.44 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) 'Rev-1512'EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONV'lEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Swiler, Charles P FILE NUMBER 21-06-0277 ESTA TE OF Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 West Shore Tax Bureau VALUE AT DATE OF DEATH 267.97 TOTAL (Also enter on Line 10, Recapitulation) 267.97 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) . REV-1513 EX+ (9-00) SCHEDULE .. BENEFICIARIES COMMONINEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Swiler, Charles P NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] FILE NUMBER 21-06-0277 ESTATE OF RELATIONSHIP TO DECEDENT Do Not List Truste s SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. Lee A Swiler 3916 Silver Brook Drive Mechanicsburg, PA 17050 Wife Total Enter dollar amounts for distributions shown above on lines 5 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 BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) January 01, 2006 - March 31, 2006 Page 1 of5 For information call: Vanguard Participant Services (800) 523-1188 -.4'" A.^^TRA..K~ AMTRAK RETIREMENT SAVINGS PLAN FOR AGREEMENT EMPLOYEES Plan No.: 092023 o N ~ Balance Hire Date: 07/07/1983 $ 35,972.35 CHARLES P. SWILER 3916 SILVER BROOK DR MECHANICSBURG PA 17050-5009 Please check this statement for accuracy and notify Vanguard Participant Services of any discrepancies within 60 days. YOUR PLAN SUMMARY Earnings Dividends/ capital gains Unrealized gain/loss Closing balance This quarter $ 34,319.92 $ 195.45 $ 3.76 1 ,453.22 $ 35,972.35 Contributions Opening balance EMPLOYEE DEFERRAL HOW YOU R CONTRIBUTIONS ARE INVESTED AS OF 04,0812006 Vanguard Windsor Fund Investor Shares 100.0% YOUR ASSET MIX Current asset mix Contribution allocation G Bonds . Stocks 18% 82% ...... ...... ....... ..... ... 100.0% . 1201 10012 ~ THEYangualdJROUP. III~ ~ 1111111111111111111111111 m 1111111111111111111111111111111111111111 / Commerce , .'Dan,1, America~MostConvenientBank@ gl J'" 1-888-937-0004 commercepc.com Balance infonnation reflects transactions through 6:00 PM on that business day. Sonie deposits may not be available for immediate withdrawal. Checks and other items are received for deposit subject to the provisions of the Uniform Commercial Code or any applicable collection agreement. 0261.08 04/07/06 0007 536757479" DDA DEPOSIT RCP $32,613.10 11:48 SIMPSON FERRY OFFICE BR-17-HB (5/05) o ACCOUNT NUIylBER PRINCIPAL VluJ Zo <0 ~u PREVIOUS BALANCE TRANSACTION AMOUNT INTEREST .0744 C 033106 32502.38 aw 32502.38 m<. 074202 RaFt 026325 SHARE WITHDRAWAL tADII. TBII SSTATB OF CBARLBS P SWILBR TBLLIm. BAR 'HII CRIIDIT UNION WILL sa CLOSING AT 1.08 p.m. on FRIDAY ,APRIL 14TH ~TB. 04/03/06 TIMB. 15.04.45 CHECK RRCHIVED BY. CHARLBS P SWILIIR 638 ALLBNVIBW DR MECBANICSBURG, PA 17055 1m FEDERAL LUE CREDIT UNION HIP 5050 Derry Street Harrisburg, PA 17111 Telephone (717) 564-3081 FAX (717) 564-1469 ACCOUNT NUty1BER PRINCIPAL UI o o <.J PREVIOUS BALANCE TRANSACTION AMOUNT INTEREST 0744 A 021204 5.00 SW 5.00 BK' 074203 RBii', 026326 SHABa WITHDRAWAL. ~YBII. TBB JlSTATB OF CHARLBS P SWILBR TJn.L1IR. BAR BII CRJmIT UNION WILL BII CLOSING AT 1... p... on .FRIDAY, APRIL 14TH "TB. 04/83/86 TIMB. 15.85.47 CBBCK&IICBIVBD BY. CBARLBS P SWILBR 638 ALLID1VI.w DR MBCBMIICSBURG, PA 17055 ~ FEDERAL LUE CREDIT UNION 1HI1IP' 5050 Derry Street Harrisburg, PA 17111 Telephone (717) 564-3081 FAX (717) 564-1469 ACCOUNT NU~BER PRINCIPAL <nUl zo <0 ::u PREVIOUS BALANCE TRANSACTION AMOUNT INTEREST 260 A 820906 185.82 SW 105.82 m.. .74201 Rill" 026322 SBARB WITHDRAWAL ~YBB. THE BSTATB OFCBARLBS PSWILBR TBLLER. BAR D CRBDITUNIONWILL BIB CLOSING AT 1.00 p.m. on FRIDAY, APRIL 14TH ~TB. 84/03/06 TLMB. 1S.03.37 CHBCK RRCIIIVED BY. CHARLBS P SWILBR 638 ALLBNVIIIW DR MRCHANICSBURG, PA 17055 00 FEDERAL LUE CREDIT UNION IHIIP 5050 Derry Street Harrisburq, PA 17111 NEW BALANCE .00 RIlC 6568 NEW BALANCE .01 RIIC 6569 NEW BALANCE .08 RBC 6566 ACCOUNT NUMBER PREVIOUS BALANCE (/lw ZQ .0;0 g:u TRANSACTION AMOUNT INTEREST PRINCIPAL NEW BALANCE :60 A 020906 105.82 SW 105.82 .00 REC 6566 tKt: 074201 REFt 026322 SHARE WITHDRAWAL ,YER, THE ESTATE OF CHARLES P SWILER TELLER. BAR tE CREDIT UNION WILL BE CLOSING AT 1.00 p.m. on FRIDAY, APRIL 14TH ,TEl 04/03/06 TIME. 15.03.37 CHECK RECEIVED BY. CHARLES P SWILER 630 ALLENVISW DR MECHANICSBURG, PA 17055 ~ FEDERAL LUE CREDIT UNION Hlr' 5050 Derry Street Harrisburg, PA 17111 Telephone (717) 564-3081 FAX (717) 564-1469 . . . . . ,- .:. .. .'. -.-. 00 . FEDERAL . LY,E CREDIT UNION 5050 Derry Street Harrisburg, PA 17111 Telephone (717) 564-3081 FAX (717) 564-1469 NO 7 Jl\it'>. ~. '~:~ . ~;:i~ ;~l~~~ CHK# 074201 REF' 026322 'AY 8L~~t,HIP ~ 1 m Sdo)s a'Zets * * ONE HUNDRED FIVE AND 82/100 ,DOLLARS.** Mid-Atlantic Corp FCU Middletown PA 17057 60-8755 2313 .0 THE ORDER OF DATE AMOUNT 04/03/06 ***105.82** THE ESTATE OF CHARLES P SWILSa VOID AFTER 90 DAYS ~-~~ ~-~ III 0 7 ~ 2 0 . III I: 2 :1 . :18 7 I:j I:j hi = III ;J =I. 1 =I. A LL Co L n 1 =t,,1 J ) , ;~~::,;, lil\l!ffi;im't1i!iiiiit li',f"'~'J,:!'!j I', !~., "'I~"; l'I""~i~,i'll ~.'!I, :i/ii ~#',i,i.' .,,~ I . '.',,; '!;;" " >'!i',-' ,'ii:II,iliO'~:I';ill /.i~ iiri ':jJ1".li<ffl'",i , "iif,;i,',...../,Ii!/J . ,,'\u "'01 ,~~ "''':::e'' ' iii ......'1:"4 , , 1:1:1 ,00 .~ - ',:" "al' .~\ ',e'.' :e: - . :' :o~,;:; I ,wf'l, W t.7~,,1 'll;, , ,,~:t.. ,1' t' ',.,' i~ i/,1l"jI" "'Wl'#~h,'I'1: I . "'Hill,,: :.'~. ill.r~.ll,'!I,.t,. '(leu); ~;, I .'iIl 11i.'1:'~.1''ii' ',JI ;/'U;,j1If, ," I r '!ii. ~!'~'i'~ :J" Sfl:ik :r'.fil.~. i.,/I"I". t., jlj;, ,.'/ /1,. 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BAR E CREDIT UNION WILL BE CLOSING AT 1.00 p.m. on FRIDAY, APRIL 14TH TE. 04/03/06 TIME. 15.03.37 CHECK REC8IVED BY. CHARLES P SWlLER 630 ALLENVlmw DR MRCHANICSBUHG, PA 17055 ~ FEDERAL LUE CREDIT UNION !-llf' 5050 Derry Street Harrisburg, PA 17111 Telephone (717) 564-3081 FAX (717) 564-1469 . . . . . I ... ';.1 .0 . I' ..... 00 FEDERAL . ~Y,E CREDIT UNION . 5050 Derry Street Harrisburg, PA 17111 Telephone (717) 564-3081 FAX (717) 564-1469 ='''1'' NO 7 lIiiir.:) "I! :::.' . '+~~~ ,~l~"." ~r .- ~I . CHKt 074201 RBF# 026322 'A y B~~EC r,HIP ~ 1 m SdoJ s 8"2cts -*ONE HUNDRED FIVm AND 82/100 DOLLARS*** Mid-Atlantic Corp FeU Middletown PA 17057 60-8755 2313 ) THE ORDER OF DATE AMOUNT 04/03/06 ***105.82** THE ESTATE OF CHARLES P SWIL8R VOID AFTER 90 DAYS n ^ ..- . '" - .~ -A'l..J-- -- #{;;V.w~f..dJ'..--/1urlT.vr-~T------~ II- 0 ? L. 2 0 ~ II- I: 2 :I ~ :I 8 ? 5 5 d I: II- 2 :I * 3 8 * * b * 0 ;i. 3 III Commerce .Bank America's Most Convenient Bank@ 1-888-937-0004 commercepc.com c:v= \,^'-- ". Balance information reflects transactions through 6:00 PM on that business day. Some deposits may not be available for immediate withdrawal. Checks and other items are received for deposit subject to the provisions of the Uniform Commercial Code or any applicable collection agreement. BR-17-HB (5/05) 0176.[8 04/10/06 0001 536757479~ DDA DEPO':; IT F,'CF' $26, D11:.. 72 14:21 Hampden Center c. \~t I ~rn ~u rn I..O~ l..O...... -I~ 0,1. -<:.::0 ~ 1:) :t: ~ -n > 2 -B -4 -:r (l) o a ~ Q. - .- ru lJ1 ~ .... ...,J o \).J ~ r - .. -< o 6 ~ -n ""'" ~ cD o o ~ (II ~ \~ e l:z~~n ~ i3' '&- 0 :.1: ~....:;@~ :z.g??C; . ~ to I>> .... 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"<mZm r m)>)>:n =i ;zorUl ~ g=~a en :o-f-fm enmzTI mS:G)O !=JCii' JJ o I m o ^ (J) T ~ ~....~ ~ ~ ~~ \J n -~ gJi ::~ ~Cb ";"~ ~~ Ol.... ~~r en UJ- 6~ go ~~ n o ::J ~ ::J iD' a tJ:l III ::J :ll:' \'!l , LIl o ~~ 0 -lf1l ~ ili Gi m c> zz ~~g g~:r ~8~ ;;:S:-l ~~~ 5~~ -l:>Jl ffi;;~ ~8f1l >m[! ~g~ lTi~CS ." -<.Jl g?Uo f~'B ~~g OCll=l ~lTi~ o ~8~ W ~~~ 6 OC1-l en ~=Jo ::E~:r f:~~ JJJJ mo m< S:(jj ~5 ;-ItJi r in -f o :I: m C") ^ III III Z (;) !< o Jl ~ )> C") :I: r in -f ru ... - - o ... OJ .r- .. LI1 U-J ~ -..J LIl -..J r -u .JJ . tfl Q ~. ~--fI MlifBank C~YISlRIBUTION TO BENEFICIARY FORM AND AFFIDAVIT 11. DEPOSITOR INFORMATION Name CHARLES P SWILER Social Security # 184 - 48 - 8643 Date of Birth 08/24/1956 Date of Death' 03/09/2006 'Attach death certificate I 2. BENEFICIARY INFORMATION Name ESTATE OF CHARLES P SWILER Mailing Address- 3916 SilVER BROOK DR. City, State, Zip MECHANICSBURG, PA 17050 Phone # 717 728-9149 Date of Birth' Relationship to Depositor* EXEC. Percentage of Plan 100 Legal Address (if different than mailing address) Customer Identification'. PA DR L1C #18057867 EX? 09/06 Customer Identification'" SHORT CERT #21-06-0277 City, State, Zip Taxpayer Identfficatlon # 20-6886564 Current Employer or Nature of Self-Employmert"" "Not applicable if the beneficiary is not an individual, such as the estate or a trust. If not an individual, attach appropriate Legal documentation. ""Required if a new Beneficiary Account is being established (two forms of Identification are required if customer is new to M&T Bank.) 3. DISTRIBUTION ELECTION (Complete Section A or B) SECTION A: OWNER DIED ON OR AFTER THE REQUIRED BEGINNING DATE (April 1 of the year after owner attained age 701/z) 1. If the beneficiary IS an individual or qualified trust, select one of the following: a) 0 Lump Sum - Distribute account in a single lump sum. b) 0 Single Life Expectancy - Make distributions periodically over the longer of the beneficiary's or owner's remaining single life expectancy. c) 0 Transfer To Spouse - Designate entire account as spouse's own (Available only if the spouse is named sole beneficiary). d) 0 Spouse Rollover - Rollover spouse's interest in account to spouse's own IRA (Available whether or not the spouse is named as sole beneficiary). 2. If the beneficiary IS NOT an individual or qualified trust, or if NO beneficiary is named, select one of the following: a) 0 Lump Sum - Distribute account in a single lump sum. b) 0 Single life Expectancy - Make distributions periodically over the owner's remaining single life expectancy. SECTION B: OWNER DIED BEFORE THE REQUIRED BEGINNING DATE (April 1 of the year after owner attained age 701/z) 1. If the beneficiary IS an individual or qualified trust, select one of the following: a) 0 Lump Sum - Distribute account in a single lump sum. b) 0 Single Life Expectancy - Make distributions periodically over the beneficiary's remaining single life expectancy. c) 0 Five Year Rule - Distribute entire account by December 31 of the year containing the fifth anniversary of the IRA owner's death. d) 0 Transfer to Spouse - Designate entire account as spouse's own (Available only if the spouse is named sole beneficiary). e) 0 Spouse Rollover - Rollover spouse's interest in account to spouse's own IRA (Available whether or not the spouse is named as sole beneficiary). 2. If the beneficiary IS NOT an individual or qualified trust, or if NO beneficiary is named, select one of the following: a) t8l Lump Sum - Distribute account in a single lump sum. b) 0 Five Year Rule - Distribute entire account by December 31 of the year containing the fifth anniversary of the I RA owner's death. 4. FEDERAL INCOME TAX WITHHOLDING DCheck Box To Indicate a Change in Prior Instructions. Amounts distributed from your IRA may be taxable as income to you in the year received. These distributions are subject to federal income tax withholding at 10% unless you elect not to have tax withheld. If you elect not to have withholding apply to your payments, or if you do not have enough federal income tax withheld from your payments you may be responsible for payments of estimated tax. You may incur penalties under the estimated tax rules if you~ withholding and estimated payments are not sufficient. You must check one and only one of the following boxes: [8] I elect not to have any federal income tax withheld from the distribution(s). o I elect to have 10% of each distribution withheld as a federal income tax. o I elect to have a fixed dollar amount of $ from each distribution withheld as federal income tax. o I elect to have % of each distribution withheld as federal income tax. (You must elect a percentage greater than 10%.) Copy to Pension Services & Customer BR-469 (12/05) w ~~~~f~':~ . Transfer to Spouse - If you are the owner's spouse and elected "Transfer to Spouse" in Section 3, indicate the account number of your own or new IRA account . Single Life Expectancy or Five Year Rule -If you selected a "Single life Expectancy" or "Five Year" distribution option in Section 3, complete the following: 1. Begin distributions on: 2. Make distributions: 0 Monthly 0 Quarterly 0 Semi-Annually 0 Annually 3. "As Beneficiary For" (ABF) Account # . Lump Sum - If you selected a "Lump Sum" distribution in Section 3, indicate how payment is to be made: [8'] Issue Check 0 Transfer to Checking Account # o Transfer to Savings Account # . Spouse Rollover - If you are the owner's spouse and elected a "Spousal Rollover" in Section 3, indicate the account number of your own or new IRA account Branch Representative BELINDA J LAWRENCE STATE OF PA ) SS. ) COUNTY OF CUMBERLAND I being duly sworn, depose and say that the information presented in Section 1 and Section 2 above is accurate and complete. I request Manufacturers and Traders Trust Company to pay me the benefits due me as the named beneficiary of the deceased depositor's IRA. For and in consideration of the death distribution payment{s) due me, I agree to hold M&T Bank, as Trustee of the IRA, harmless from an~ anjjlliability, costj' losses, expenses or damages of every kind whatsoever, which may occur as a result ofthis distribution. X ">>).)0 .:h.JJJ!fru ~:e.L, ~~/5 f / orb PADR UC#18057867 EXP 09/06 Signature of Beneficiary ) I . Date Customer Identification Subscribed and sworn to before me this 31ST day of MARCH 120~ Notary Public Copy to Pension Services & Customer BR-469 (12105) w NATIONAL RAILROAD PASSENGER CORPORATION .I 30th Street Station, Philadelphia, PA 19104 A^^TRAK ~~~ May 10, 2006 Mrs. Charles Swiler 3916 Silverbrook Drive Mechanicsburg, PA 17050 Dear Mrs. Swiler: Enclosed please find a check in the amount of $2,763.68 for final vacation monies due your husband. Please accept our sincere condolences for the loss of your husband. If we can be of any further assistance please let us know. 7~~ Linda Honnoll Human Resources Specialist c . 002310 NATIONAL RAILROAD PA~SENGgR CORPORATION Shortage occurred in The Pay Period Ending 3/15/2006 Check Date 5/10/2006 Location/Check Sequence phi6 Name Employee No. PA Site Number Lee Ann Swiler Gross Earnings $0,00 194429338 RRTA Tax 03 045018 $3,219.20 Federal Tax $387.92 State Tax Local Tax $67.60 OTHER Net Pay $2,763.68 $0.00 Other Deductions $0.00 Original Check Number: 5508760 Reason Code/Description: 17. non-amtrak employee Please Enter Reason for Other UClt. PCU1- "