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Home My WebLink About10-11-06 .-J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 21 05 0516 Date of Birth 211-42-8617 OS/26/2005 08/26/1952 Decedent's Last Name Suffix Decedent's First Name MI Swartz Mary Lou (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 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. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of. Safe Deposit Boxes Chris Sheffield, Esq. Firm Name (If Applicable) Sheffield Law Firm, LLC (717) 262-0025 REGISTER OF WILLS USE ONLY {.- ~,,) _."~ :-':'"J -L..i-' ::0 1"T1 (:J C") fl:3 I~h CJ C) --iI :1J :~fy1 C"") ., i 1 First line of address 230 LWE, Suite B -'J r-:~) ) --i Second line of address P.O. Box 430 City or Post Office Chambersburg State ZIP Code .., DAn;Fil~O v ....... PA 17201 ; :-..j (.,) c..} Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG JURE OF PERSON SIBLE FOR FILING RE RN DATE - '-- . _o.__.____ ____.-'-~ -IC:>-IJ/' D&liiSS/! S1G~{~; ; J? __W~{rJ:-f ;~~PR~1~f:.~M k.,}__~.fJ1--1:) d._f'7______ DATE I" -IC>-D /- .-- ..... ----_._-..__._----,._.~-- f4- f'lJ..o I SE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 ...J .....J 15056052059 REV-1500 EX Decedent's Name: Mary Lou Swartz RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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).. .. . , .. ......... ... .. ... ... ...... . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. 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_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X. 15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... . . . .. . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 211-42-8617 Decedent's Social Security Number 100,000.00 33,247.93 0.00 0.00 58,303.99 0.00 0.00 191,551.92 5,389.00 0.00 5,389.00 186,162.92 186,162.92 0.00 0.00 0.00 0.00 0.00 0.00 15056052059 -.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME Mary Lou_ _____ ~_~""a~ ._~__. ~ STREET ADDRESS 6 South Queen Street File Number 21 05 0516 DECEDENTS SOCIAL SECURITY NUMBER 211-42-8617 CITY Shippensburg T STATE --. I PA -_..-~-..~--T.~---- . 17257 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + 8 + C ) (2) 0.00 - Total Interest/Penalty ( D + E ) (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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (58) 0.00 0.00 0.00 0.00 0.00 A. Enter the interest on the tax due. 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;.......................................................................................... 0 [KJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [KJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [KJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [KJ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 four and one-half (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 twelve (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. .~ REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No. 2005- 00516 PA No. 21- 05- 0516 Esta te Of: MARY LOU SWARTZ fFim. MiMIP. LntJ Late Of: SHIPPENSBURG BOROUGH CUMBERLAND COUNTY Deceased Social- Security No: 211-42-8617 WHEREAS, on the 9th day of June 2005 an instrument dated March 1st 2000 was admitted to probate as the last will of MARY LOU SWARTZ (FilM. Middle. uMJ la te of SHIPPENSBURG BOROUGH, CUMBERLAND County, who died on the 26th day of May 2005 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: SUSANNE K BRENNAN who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 9th day of June 2005. ~\flfJ. 4CVLn..pJ-.. '- :tk:rHl ~hlijdL.l .J RegISter of Wills U ~ C~ (L >v5t. , Deputy LAST WILL AND TESTAMENT of Mary Lou Swartz I, Mary Lou Swartz, currently residing at 6 S. Queen St., Shippensburg, Cumberland, County, Pennsylvania, being of sound mind and memory, declare this to be my last will and testament, hereby revoking any and all prior wills and codicils. Disposition of Remains FIRST: I direct that my body shall be cremated and buried around a tree planted in memory of myself, on the grounds of the Oasis of Love Church, 303 South Washington St. Shippensburg, PA 17257. Distribution of Personal Property SECOND: I give and bequeath my entire estate in accordance with the " Distribution of Residue" below. Distribution of Residue TInRD: My entire estate, both personal and real, I bequeath to Deliverance Temple, Inc.! Oasis of Love Church of Ship pens burg, 303 South Washington St. Shippensburg, PA I have chosen not to bequeath any of my estate to my mother or siblings despite my love and affection for them. I have chosen to distribute my entire estate to Deliverance Temple, Inc.! Oasis of Love Church of Shippensburg because I have devoted my life to the work of the Lord, Jesus Christ. Anti-Lapse Provisions FOURTH: Ifany gift herein fails to vest with the designated beneficiary, then my estate shall be distributed in accordance with the Pennsylvania Probate, Estates and Fiduciaries Code, with the designated executor herein named acting as executor. Page 1 of4 rnmALS 14- FlFTH: If any income or principal shall be. . or who shall be incapacitated for any reason, my executor as ... ........ principal dwing minority or incapacity and shall be entitled to apply sucb,inC:\1mff ........................................ . .............. health, maintenance, support and education of such person during minority or incapacity WitOOot the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upOn the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor. My executor shall have the power to establish a trust with a recognized bank or trust company to carry out the foregoing functions in part or in whole. The selection of such bank or trust company shall be at the sole discretion of my executor. Payment of Burial Expenses and Death Taxes SIX1H: All expenses of my last illness, my funeral and burial, and administration of my estate are to be paid from assets of my estate. All estate, inheritance and other death taxes, together with interest and penalties on them, payable with respect to property or interests subject to taxation by reason of my death and whether passing under my will or any codicil thereto, or otherwise, including jointly held and other non-testamentary property shall be paid out of the principal of my residuary estate without apportionment. Powers of Executor SEVENTH: I confer on my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments, and transfers of the property, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments"; to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. Page 2 of4 INlTIALS~ EIGHTII: I appoint my of my last will and testament. Iffor any reason Susanne> as executor or having qualified is unable or unwilling to adS. Thompson, as personal representative, executor, of my last will Waiver of Bond NINTH: I direct that no fiduciary hereunder shall be required to furnish bond in any jurisdiction, and if any bond is necessary, no surety shall be required. Interchangeability of Language TENTH: Words used in the RillgJllAT may be read to include the plural or the plural may. be read as the singular. Similarly, the ma.~r.111ine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. Headings ELEVENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this Last Will and Testament this I day of /f~cl/ . 2000. -1~~_or ~hPL l)2rw Wi ss:f'JiLO{-( [). Nt-~+ Address: ~ 7f? 130K 133 J?:i.u-rJ- eoJ::>.fns I Po. 172ft? &.~~... ~ Witness: \E!-("~ ~\~ Address: \ t'1.~'"1. \\cl.\':1 ~ (iL ~~~I ~ \~O\ ~ P~lT'" ~ "f'.4 ThTTTI AT (: J/17..Jl Commonwealth County of Franklin We, the testator in and the undersigned witnesses to the will, the attached or instrument, who have signed the instrument, having been qualified according to law do depose and say: ( a) that L the testator, do hereby acknowledge that I signed the instrument as my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testator sign and execute the instrument as hislher will, that (s )he signed it willingly and executed it as hislher 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 a witness 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. ~ ML 12. /tU-- WI S C ~W^~~ Witness Attorney's Certification to Self-Proving Affidavit Commonwealth ofPeIUlSylvania ) SS County of Franklin ) ~ - On this, the %!.. Oay ofR J?~~ N . 2000, before me /&u~ "" ~~ . the undersigned officer, personally appeared Christopher E. Sheffield, known to me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that he was personally present when the foregoing acknowledgment and affidavit were signed by the testator and witnesses. I have signed my name and affixed my seal. k//~ ,ffl"otary Public, My Commission Expires 10 RIAL fA ROIALDE. tM.l, NmARY.~. ._ CHAl8at8BUJte. FR~Le~'N' . ~ COIIII18IOIf EXP.. . n. . -. Page 4 of4 INITIALS Ad REV-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary Lou Swartz 21-05-0516 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly.owned with right of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 6 South Queen Street, Shippensburg, PA 17257; Residence VALUE AT DATE OF DEATH 100,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 100,000.00 --.-..~ THIS DEED ~ Made this / ~ day of July in the year of our Lord two thousand and five (2005). . BETWEEN THE ESTATE OF MARY LOU SWARTZ, hereinafter referred to as Grantor, said Mary Lou Swartz having died testate on May 26, 2005 and Letters Testamentary having been granted to Susanne K. Brennan, Executrix of said Estate, on June 9, 2005 and duly recorded in the Cumberland County Register of Wills Office; AND KEVIN W. WILSON and MEUSSA R. wasON, husband and wife, of 6 South Queen Street, Shi~burg, Pennsylvania, hereinafter referred to as Grantees WITNESSETH, that for and in consideration of the sum of ONE HUNDRED THOUSAND DOLLARS ($100,000.00), in hand paid, the receipt whereofis hereby acknowledged, the said Grantor does hereby grant and convey, in fee simple to the said Grantees, their heirs and assigns, ALL the following described real estate, with improvements thereon erected known as 6 South Queen Street, Shippensburg, lying and being situate in the Borough of Shippensburg, Cwnberland County, Pennsylvania, bounded and limited as follows: BEGINNING at a point on the curb line of Queen Street; thence by Lot 1 on plan of lots hereinafter mentioned, by the centerline of an automobile driveway, westwardly to the line of lot now or fomerly of Israel Brown Estate; thence with the said lot southwardly 50 feet to a stake at comer of Lot 3 on said plan; thence eastwardly 80 feet with said Lot 3 to a point on the curb line of Queen Street; thence northwardly with the said curb line 50 feet to the place of beginning. BEING Lot 2 on plan of building lots recorded in Cumberland County Plan Book 2, at Page 68 &c. AlSO BEING the same real estate that Lester R. Wingert and Janet R. Wingert, husband and wife, by their deed dated February 20, 1998, recorded in Cumberland County Deed Book 172, Page 555, conveyed to Mary Lou Swartz, single woman, testator of the Grantor herein. TOGETHER WITH AND SUBJECT TO an easement for a driveway as set forth in the abovementioned deed as fully as though written out at length herein. AND FURTHER SUBJECT TO the conditions and restrictions as set forth in the abovementioned deed as fully as though written out at length herein. And the said Grantor hereby covenants and agrees that it will warrant specially tile property hereby conveyed. IN WITNESS WHEREOF, Executrix for the Grantor has hereunto set her hand and seal the day and year first above written. Signed, Sealed and Delivered in the Presence of C/ //I(lt?~ ~4f/Jl#_~_& Susanne K. Brennan f Executrix of the Estate of Mary Lou Swartz COMMONWEALTIi OF PENNSYLVANIA: : S8 COUNTY OF CUMBERLAND On this, the /5 day of July, 2005, before me, a Notary Public in and for said County and State, the undersigned officer, personally appeared Susanne K. Brennan, Executrix of the Estate of Mary Lou Swartz, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the pwposes herein contained. IN WlTNESSWHEREOF, I hereunto set my hand and official seal. QQMMoNWEALTH OF PENNSYLVN4fA NOTARIAl SEAL D~BORAH WARREN, Notary. ~ I Shlppeusburg Twpo. Cumbertarid County My Commission ExpIres ~~. ._~! 2005 . W ~1l/liA.) Notary Public I do hereby certify that the complete address of the within named Grantees is 6 South Queen Street, Sbippensburg, Pennsylvania, 17257. JmY~2005 <:::::~~ mey for COMMONWEALTH OF PENNSYLVANIA: : S8 COUNTY OF CUMBERLAND RECORDED on this day of . Office of said County, in Deed Book . at Page . A.D. 2005, in the Recorder's Recorder y ,~/ ~ flTATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 9th day of June, Two Tbousand and Five, Lett.ers TESTAMENTARY in common form were granted by the Register of said County, on the estate of MARY LOU SWAR7Z , late of SHIPPENSBURG BOROUGH "... MiiIIIt. lMIJ - --.--.-- in said county, deceased, to SUSANNE K BRENNAN (Fbr. MiiIIIt. lMtJ and that same bas not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 9th day of June Two Thousand and Fi ve. File No. PA File No. Date of Death S.S.# 2005-00516 21- 05- 0516 5/26/2005 21142-8617 '-..-kTh ~ n &.0. \l'O.JlJ W,- \~~'"'D. '-'\"" < RSf/lSter , '~ \\. f',. . . [I " ,,-( _ ~....,-,~ 'J Deputy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL REV-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Mary Lou Swartz FILE NUMBER 21-05-0516 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION T.Rowe Price - Account # 540233457-3 Mutual Fund VALUE AT DATE OF DEATH 33,247.93 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 33,247.93 .. Miffiiil Fund Statement .........,..'"'.&&~ - INVEST WITH CONFIDENCE I(yau have-qu~oti$.pleasevisittro_price.com. or call T. Rowe Price-Mutual Funds at 1-8O().225-S132. . . __ ___ . . _____m.._..._ InvestorNurriberS6630010 11883i11 O1ABG.301.AIJtO- T80255317201.(J43030- M1 1...III..il i.I.III......IIII... .1..lnll.II... ..II.II_".lil..1 T ROwe Price Trost Co CustFor1he IRA Of .- Marylou Swartz(Dcd) Est ~ryLou.Swartz(Bene) PO Box 430 - Qlarnbersburg PA 17201.;()430 = - - .. - - - - - .. iiiiiiiii& - ===== == . !!!!!!!!!!!! I ,.arkefValue:. SOJ)e>> The l11aximul11 contribution forlRAs Is $4~OOOfortax-years 2005 and-2006.ForlnvestorsSOyearsoralder.the .catch up. conttibution is an extra $500 for 2(K)S and $1.000 for 2()Q6; Call 1 :-8oo:':225-5:t.32 foftnOte details. A ( t I V tv 5 ,l r TI ''i a 'Y - - -This-QUarter Yea,..to-Oo;e* ~~~!'.!!'-!!~~~-_...__.._._.._--_._.~:~_..__.._..__.._.~:-~.. Additions 33,257.93 33.257,93 ........__.._......_._..._~_..._.__.__________________...____....___...__........_........__....a_..__..................._.__..._......_..........._... Deductions 33.257.93 33.257.93 .._..,....._.................6'.............___.....____.....__.........._..__~___~_........_..._.......__................._........._..___....................._.._.._..__..._.._..___....__.. IncOme 0.00 0.00 ...............-.-........--......-.........--..-....-..-----..-----....-....------.......---.......................................-...................... Market AuctlJatioI10.00 0,00 EndineValue $0.00 SO.oo Net Change $0.00 $0.00 ilVear.tcHlate income .lIIiIYindude -closed accounts no1oncer shown on. this .statemenl r Rm\e f'rllf Rr-t'renl<:,n: )0(,0 FLlnd Account Number 540n3457-3 T Rowe Price Trost Co Cust for The IRA Of MarylOU. Swartz(Ocd) Est Marylou Swartz (Bene) Tele*AccessCode-Ddte At.tltJIty This Year Amount Shares Share Price 113 t/t ... -Beginning Balance $0.00 0.000 $0.00 Ticlcer Symbol .-- -. ._- :!~~~~I~!!~~fi.~~~11~~1~~~~~~~==:~~~:~=::~~:~:~:~:~~:~:::~~:::::~~:=:==~~~~~::~~~::::=:~:~~~::::~:f.~~~~!~?:::::~:::::::::::::::::::::~:~~~:. . TRRDX ..... I~!-~~~..~.~!~~~pu.!.'!~p.,~!!!L___.._.c_._~_._______,__,.~"~______..____'_!.~L~~.~:!~__.'_,.____._'_.~~~~!~:.~~~_...._..........,.,,,...~~.:~~.: 10/6 Admini~-!CItive fee . 10.00 -0.631 15.86 12/31 Ending Balance $0.00 0.000 -$0.00 Please be aware that weare required to report youryear-end IRA accountvalues to the IRS. j ~ - Pap 1 ofl REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mary Lou Swartz FILE NUMBER 21-05-0516 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Miscellaneous Personal Property in Residence 2. Manor Care Reimbursement 3. Savings Bonds 4. Travelers Checks 5. Nationwide Fire Insurance Reimbursement 6. M & T Bank Account 7. Aetna Life Insurance 8. Unum Provident Health Care Insurance Benefit VALUE AT DATE OF DEATH 500.00 111.82 100.00 190.00 171.00 449.44 50,569.01 6,212.72 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 58,303.99 it it it . . . , : . .. .. . . . .' . it '. . "..-'" .... . .. . it .' it ,.. " ~ .,. .~. '. '.. .... . ..;:- . .. .. .' ,. .. . . ,. ". " ' .,. " .': . , : . - .i?";i c, = - -= ::: - ..:: ~ ,,';$ ::::: 1 :::: .::: .:::.:::> :0 --.: 'e..J ..:: .:::>- ...E~ Q - " 1-(:)- ::: "- V)~~ ..:: 0 ~.:::> I ..:: 1.uco" ~ ~~~~;fJ" .::s" rt 0: O'a.. ~ .::: iZ~V)~ V)('O.:t:-"t' (I). a.. fil ..'~ ~ , ,!g O' .' . .:to . :...~~ ~o'O J.:;6Cj " - : l - ..:: --: -= 1 ..:: ,~ '''~ ~i:};:, :::: .. .. .. .. -= ::: ..:: .. ..:: .. .. ..:: ..:: -: -: -: ~ ..:: ::: .. .. -: I I Cl ~ I l 1== ~ Q Q . - ..: !l iff S.:4 5-:>> ~;l;; i': a fi: c1~N rso.'5 :~.s ~-~ I.!!t ~ _.W. ~ Q; v :.- '__ :i c-..> .~ ;f f1.I r;; ... & J t f1.I ~ (\.. tr: o .~ :.. ~ . !f1 :: ;::: a- & c.l1 Ii ... If o ~ CQ s: .r ~ CQ <l' t.n :tl . :t' :: ,... ~ ~ g ~ ~ i2 g l1J '$ ~ ~ is ~ ~. I f 11.1 ~ '" tr: 8 ~ e ~ ili & S ~ l ~ t i l ftf {IJ ~ 11.1 ...I e ~ <l' "= <l' !t' o 5 ~ c.D f1.I CQ t.n ... ... o o Q]J ~.. ~I ..... . C\J ~ ~i ,., ~.g ~ lj en rf t C\J I~ i'< EZ I ~.; I )8 _I ~ ! ~ I~- J~ 1--: > ~ii ii --------, --....; JlL' d3 jf') ~ II') O~ ("-I ......... CD C--.! 0- -0 -~ ........ <l" "..,.. Co (;) Co .... ....... <l" <l" "'0 t::: NIli ..... 0::. 011 <X: C ::lI: .... ;.n % W _. ~ o :::1>- 0..., -l !:- Co :- u.. 0::: <l:: "'0 ;E: .:J !:- i.J-'''O o {:' l.LJ~~ tG <L~....-! !"'- :i ~ ".J"J .:. c.. i..LJ l4. !=,o: II.. o Wa: >~~ <Oa: Cl..F-0 :Ie /J fl- 'oil ::I it I ) () ~L~ ~'1K:~! toIl>O M3N ~iM: Lroel~S<:lI'e J J :J ,.) -, !: a co .... ru co ~ L11 co co ru a a co LD .. - a- ~ a- a a a ru a .... .. - !: ru ~ L11 ru ..z ~ !: ,J -.J AETNA LIFE INSURANCE COMPANY 151 FARMINGTON AVE. HARTFORD,CT 06156-3007 NUMBER 50806667 SHEFFIELD LAW FIRM, LLC ATTN: CHRIS SHEFFIELD PO BOX 430 230 LINCOLN WAY EAST STE B CHAMBERSBURG PA 17201 03-21-06 RE: EMPLOYEE- MARY L. SWARTZ EMPLOYER- ALLFIRST CSA- 702720/16/001 DATE OF LOSS 05-26-05 THE ATTACHED PAYMENT REPRESEl.:JTS-'THE BENEFITS DUE' 'UNDER THE 'GROUP POLICY ~S EXPLAINED BELOW: LIFE BENEFIT INTEREST $ 50,000.00 569.01 TOTAL : $ 50,569.01 rAXABLE INTEREST HAS BEEN CALCULATED FROM OS/26/2005 - 11/04/2005 AT rAXABLE INTEREST HAS BEEN CALCULATED FROM 11/05/2005 - 02/02/2006 AT rAXABLE INTEREST HAS BEEN CALCULATED FROM 02/03/2006 - 03/21/2006 AT 1.00% 1.50% 2.50% rF FURTHER BENEFITS ARE PENDING THE RESULTS OF AN INVESTIGATION, OR IF ~DITIONAL INFORMATION IS NEEDED, AN EXPLANATORY LETTER WILL FOLLOW. [F YOU HAVE ANY QUESTIONS, PLEASE CONTACT LIFE CLAIM SERVICE CENTER AT 1-800-523-5065. . Aetna life Insurance Company 'f'l;i;~_!i;~~;{;a~l~v '~~!,~7' . . ;,_i;,'~1; "\'~1,'3~j'(';::';'; ...., ".~",;;, .....;t,.';'. .Ib1$~qE'. ,,iN.., ~.~.::-/.'.';~ ~t; October 12, 2005 CHRIS SHEFFIELD SHEFFIELD LAW FIRM LLC PO BOX 430 CHAMBERSBURG, PA 17201 RE: Mary L. Swartz Claim Number: Policy NUmber: DOB: August 26, 1952 0098935605 00519821 - 0001 Dear Mr. Sheffield: Thank you for providing us the information that we requested regarding the survivor benefit. Under separate cover, we are sending a final benefit check payable to Ms. Swartz's estate, totaling $6,212.72. This check includes benefits for the period from May 01,2005 through May 25,2005 in the amount of$I,350.59, and a survivor benefit in the amount of$ 4,862.13. A copy of our calculation is enclosed for your review. If you have any questions reg arding this benefit, please feel free to call me at 1-800-822-9103, extension 56349. Sincerely, ~ >{<',~ ?;14IfC) /7I,/J(IC4.../11 " /'KJI'l.-"" (// 't /1 ........ }' ~ I / Linda Liberty v Customer Care Representative LL/lI lJNuMllFE ~ CbMPANYOF AMERICA P.Q Boz 9SOO Pordmd. Maioe 04104-5058 207.575-2211 1-8OQ.822-9103 Fax 1-800.#7-2498 REV-1511 EX+ (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mary Lou Swartz FILE NUMBER 21-05-0516 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. AMOUNT B. 1. 2. 3. 4. 5. 6. 7. DESCRIPTION 1. FUNERAL EXPENSES: Prepaid by decedent 0.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Susanne K. Brennan Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 329 Walnut Street 0.00 City Shippensburg State PA Zip 17257 Year(s) Commission Paid: Attomey Fees 5,000.00 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 0.00 Street Address City State . Zip Relationship of Claimant to Decedent Probate Fees 389.00 Accountant's Fees 0.00 Tax Return Preparer's Fees 0.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,389.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17G13 Receipt Date: Receipt Time: Receipt No.: 6/09/2005 10:15:28 1040915 SWARTZ MARY LOU Estate File No. : Paid By Remarks: 2005-00516 SHEFFIELD LAW FIRM JA ------------------------ I Receipt Distribution --------________________ Payment Amount Payee Name 260.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 5 . 00 CUMBERLAND COUNTY GENERAL FUN 20.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D ---------------- $310.00 $310.00 Fee/Tax Description PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE JCP FEE Check# 1102 Total Received......... REV-1513EJ<"9-00' .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Mary Lou Swartz FILE NUMBER 21-05-0516 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)] 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 BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Oasis of Love Church of Shippensburg, 303 South Washington Street, Shippensburg, PA 17257 100% TOTAL OF PART 1/ - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) -