HomeMy WebLinkAbout07-13-07
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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 07
0142
Date of Birth
193-12-9357
01/31/2007
02/19/1920
Decedent's Last Name
Suffix
Decedent's First Name
MI
Hartman
Jayne
c
(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 Retum
2, Supplemental Retum
3, Remainder Retum (date of death
prior to 12-13-82)
5, Federal Estate Tax Retum Required
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
4, Limited Estate
.
6, Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8, Total Number of Safe Deposit Boxes
John M. Eakin
(717) 766-382 ;i~
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REGISTEj:t:-diwILLS U$t>NLY
~;: (; r:::=
Firm Name (If Applicable)
First line of address
w
Market Square Building
(-)
--il
~
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-y
I nil
- :!]
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Second line of address
. :,;"J
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C)
:......]
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City or Post Office
Mechanicsburg
State
ZIP Code
DATE FILED
PA
17055
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, co and complete, Declaration of pre rer othe than the personal representative is based on all information of which preparer has any knowledge,
N ES I E FIUN TURN DATE
07/12/07
echanicsburg, PA 17055
HE'V'"~ REPRESENTATIVE
-----~'------------- ---- - -------
DATE
07/12/07
ADDRESS
Market Squ re Building, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
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15056052059
REV-1500 EX
Decedent's Name:
Jayne
C Hartman
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 45 690,848.64
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
193-12-9357
Decedent's Social Security Number
308,000.00
382,367.04
28,798.14
719,165.18
23,892.62
4,423.92
28,316.54
690,848.64
690,848.64
31,088.19
15056052059
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number
I; itf/'
21
07 0142
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Jayne C Hartman 193-12-9357
STREET ADDRESS
5 South West Avenue
CITY I STATE I ZIP
Shiremanstown PA
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
31,088.19
24,000.00
1,263.12
Total Credits (A + B + C ) (2)
25,263.12
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
5,825.07
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
5,825.07
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;.......................................................................................... D ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~
c. retain a reversionary interest; or.......................................................................................................................... D [iJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [iJ
3. Did decedent own an "in trust fo~' or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D ~
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 PS. 99116 (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. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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-1502 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman Jayne C. 21 07 0142
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 orooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
Canton Township, Bradford County, sale price reported, see attached
VALUE AT DATE
OF DEATH
58,000.00
2.
House and Lot 5 S. West Avenue, Shiremanstown, Cumberland County
sale price reported, see attached
150,000.00
3.
Monaghan Township, York County, sale price reported, see attached
100,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheels of the same size)
308,000.00
A. Settlement StI18l1lllnt B. Type of Loan
105- loan Type COllY. Unins.
Commerce land Title, Inc. dba Commerce Company 6. Fill Number 7002258
Settlement Statement 7. Loan Number 400094015
8. Mo~ge Insurance Case Number
C. Note: This 10m is ftrnished 10 give YOO . ,111~1 of a;tual Seluemonl co.l&. Amounli paid 10 and by Itt, aelUemenlll!jelll are snown. ilarm; marked '(POC)' wert pa; OllIS/dO lhls _~: Ittoy '" ihown
h... for inmnaIionll pu_ and Ire nollnCludal in 1M IOtaIs.
D. tlBrne of Borrower: David J. Strock, Karl Thome-Strock
600 Welit Main S1reet, Mechanic$burg, PA 170~
Eo NBm8 of Seller: Estate of Jane C. Hartman
S South West Avenue Shlremanstown, PA 17011
F. Name 01 lender: CTX Mortgage Company LLC
3100 McKinnon St, 3rd Floor
Dallas, TX 75201
G. Property Location: 5 South west Avenue, Shirell1an5town. PA 17011
H. Settlement Agent: Commerce Land liUe, Ine. db, Commerce Company l
AddrelS: 581 Boston Mills Road Suite 100, Hudson, OH 44236 Setllement Dalll: 0612612<<17
Place of SelUement Address: 511 Boston Mil.. Road Suite 100, Hudson, OH 44236 PlintOll18: 06I26/2ll07,11;1ZAM
Disllumrnent Date: 06I26l2OO7
J. Sumlllilry of Borrower's Transaction K. Summary 01 SeHet'G Tranuction
100. GIO$$ Amount Due From 1I0llOWllr 4llO. Gross Amount Due To Seller
101. Cool1act Sal$s Price 150,000.00 ~01, Conlmct Sales Price 1~,OOO.OO
102. PelJOfll\l Property 402. Personal PI'OP'rty
103. Selllement cherget \0 borrower (fine 1400) 6,8n.1lIl 403. Tolal ~i1s
104. 404,
105. 405.
Adjustments lor ItBms paid by saller in advimoe AdjUGtnleIlt$10r Items plIid by seller In advance
106. Cilyllown taus 06127107 to 06lJ007 @$11151.37/yt 15.22 406. City/lu.vn illxes 06127107 to 0613007 @$1851.37/yr 15.22
107 Countylaxes f16/2710710 1~1107 @S391.27Jyr 200.46 4fP. County 1axes f16/271fJT 10 12/31.107 @$3$1,'Dlyr 200.46
1 ca. Assessmenl:l 408. Assessm8ll1s
1011. 2007 Bcro Taxes f16/271071P 12131.07 @S317.46/yr 162.64 409. 2007 60Ill TllJle.9 00Il1107 to 12/3Ul7@$317.<46Iyr 162.64
110. 410.
111. 411-
112. 412.
113. 413.
11~. 414.
115. 415.
120. Gross Amounlllua From Borrower 157,250.76 420. Gross Amount Due To Seller 150,37B.32
200. Amounts Paid ByOrm BahalfofBorrower 500. Reducdons In Ainounl Due to Seller
201. Oeposk or earnest mOllllY :501. Exce6s cIepos~ (eee il15lnldions)
202. Principal amount of new lcan(s) 120.000.00 502. Se1Hemenl charga (Bne 14(0) 1.500.00
203. Existing roan(s) la~n subject 503. Existing loan(s) taken ~bje<;t
204. Eamast Moolll' Oepos~ 5,000.00 504. Payoff of Drst morlgaga loan
205. 505. Payoff of sean! mor1gage Ioen
206. 506. z001 County T_ to Cumbetland County Treasun.r ~91.'27
207. 507. 2007Taxes to ShirtllllllflSlown Borough T2X 317.46
208. 508. m7 r_ 10 Sc:hoollax POC $1.1151.37
209. 509. Earnest Monay Deposit 5.000.00
Ad)JS1menIs for ItBms unpaid by Geller Adju5lments for items unpaid by seHer
210. Cilyllown la.e5 510, CityllDwn tlXll-l
211. Coun1y taus 511. !,;OUnty laxet
212. Assessmenls 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516,
217. 517.
218. 51a.
219. 519.
220. Total Paid BylForBonower 125,000.00 520. Total R.eduC\lon Iunount Due Seller 7,208.73
300. Cash At Satdament FnomITo IIorrower 600. Cash At Settlement ToII'rol1l SeRer
301. Gross iInlOunt due frOJIl BOITOMr (line 120) 157,250.76 601. Gross amount due to Seller Pine 420) 150,378..s:z
302. Lno amOllnlli paid Ir1I1or IIolTllWtr (lIne 22Il) 125,000.00 602. Lt$5 reduolions in amounts due to Seller pine 5211) 7,208.7<5
303. Cssh (X Froml( To) Borro..., 52,250.76 603.. Cub (XTol( From) Seller 10,161.!l9
The HU[).1 SelUernenl Sllllement which I have prepared is a true and acaJrate account of this transaction. I have caused or win cause the funds 10 be
disbursed In accordanc:e with this stalement.
Settlement AQent .. ", ..-. ..." Date: ..
. Saa SUJlpJornentol Page for delAlib.
OMS Approval' No. 250,H1265
JUN-26-2007 TUE 09:53AM 10:
PAGE: 2
File No 7002258
L. Settlement ChillIeS
700. Total Sal8cllllOktr's Commission based on price , Paid From PaId From
Olvlelon Of COll\'nission (line roo) as follows BOrTllwer's Sellir'i
Funds at FlDlds at
70t SelUement Settlemenl
702.
703. Commission paid at SeWement
7lJo1.
600. IIIms Payable in Connection willi lOIll
801. I.JlQn QIlglnatioo Fee
602. LOIII1 Discount
803. Appm~81 fee . Robert cassel 325.00
604. CredJt Repolt - Fl"5t American Cnldoo ZIl.OO
!O5. Lendets InspedIan Fee
806. Mongage Il15uJilnce AppIK:a1ion Pramlum
607. Assu~lIcn Fee
808. Tax Selvice Contract - CTX MoIIgage Company LlC 78.00
809. CommItment fee . CTX MOI1llaIIe Company LlC 312.50
610. Flood Certlee. CTX Mortgage Qlmpany lLC 10.00
811.
812-
613.
814.
Supp18m1ln1llJ Summal'f
900. llaltl$ Reauired bv lenderto be PaId In AdvIIIce
901. InleleSl06l26l07ta 07101107 @S22.1~I000klay. (;TX MJr1Q1l\Ie Company LlC 110.96
902.
903. H8lllnlln:lurlIllCl! Premium lot to Hwtd Im;uranee 427.00
904.
906.
S!Jllplemental SummlllY
1000. Reserves DepOsilvd with lender
1001. Hazard Insurance 3 mo(s) @$3!i.581mo 106.74
1002. Mor1Q8\le InsUJilnc8
1003. Cily Property TDes 5 mots) @$53.69/mo 258.45
1004. Gounlyf'ropQl\yTaxes
1005. Annualassessrnen1s
1006. School tax 13 mo(s)@SI54.28/mo 2,005.64
1007.
I 008. ~gre9ale AQ;Oun1ilJo/ Adjustmenl .285.91
HOO. litle ClllrJles
1101. SetlJemenlordosing fte - Commerce Land TJ1Ie, Inc. dba CommlllCll Company 200.00
1102- Absi3t:I or UUUelIr(;h
1103. TJ1Ie examimrtion
1104. Ti6e Ill5lInmee Bildel'. Comrnllrce ~d TIne, Inc. dba Commerce Company 60.00
1105. DoaJment Fee
1108. Nol2ly Fee
1107. AttameyFee
(Includes above item numbers: )
11011. TJ1Ie Inou!'lllCll- See supplemenllll page lor breakdown 01 indlvldu;aJ fees and p&yee:i 1,275.06
(includllS 8bove I\em nll/llbers:
1109. lendets cove~ $120,000.00
1110. o..ner's covqe 5150.000.00 Premium: $1,275.06
1111. DllClJll18f1t PrepaIlltian - !;Qmmelte Land TJ1Ie. Inc. dba CDlTlIllQICQ Company 100.00
1112. Nollll'f Fee . Commerce Land Titkl, Inc. dlla Co""",,,!iitC<<lip:;n;- - 10.00
1113. Exhlb~ Pee - Contlllerce I.and litle.lnc. dbII COliuilSioocompiin{ --- ----.... 150.00
1114. Delivery SVl3-HandlAomln; Wire Fee - Ccmmelt:ll Land litle. Ioc. ilb8 ~compaiiY' 60.00
1115.
1115.
1117.
1200. Govemlll9lll RtcordinQ alld rfill15hlrCbllfllel ~__'__~.'_'.V'_'
1201. 'RllCOIdIng 1M$: Oeed$45.oo Mortgll\le S!lO.lXrR~SO.OO 135.00
1202. -cilyltcunty 1uIs1amps: ()QQ(\ $3000.00 Mortulll/tl $0.00 1,500.00 1.500.00
lWJ. SIllIG lllXistampo;
1204.
1205.
1206.
1300. Addillonal Selllemenl Chemes
1301. SuMlY 10
1302. Pesllf15PllClbn ID
1303.
1304.
1305.
1306.
1307.
lJ\J~.
1309.
1310.
1311.
1312
1313.
1314.
Supplelll9lllal SuffilT1aly
1400. lollll SettJem9lll eM'lles (enter on lines l03,llection J and 502. 5ec:tion K) 6,872.44 1,500.00
JUN-26-2007 TUE 0~:53AM 10:
* See Supplemental Page for details.
PAGE: 3
FileNo.
Supplemental Page 7002258
HUD-1 Settlement Statement
Commerce land Title, Inc. dba Commerce Company Loan No.
Settlement Statement 400094015
SettJllIlIent Date:
06/2612007
Borrower Name & Address: David J. ~k, Karl Thome-Slrock
600 WllSt Main Street, Mechanlcsburg, PA 17055
Sener Name & Add,",: Estate of Jane C. Hartman
5 South West AVllllll8 ShiremanstolMl, PA 17011
Paid from Paid From
Section L. S.lIlement Charg.. continued Borrower's Setlet.
Funclsill FUnds ill
Selllemenl lieUlemont
1108. Sup~l Summary 1,::175.06
8) AL TA EnhlIracI Owner Policy - Commen:e Land Title, Inc. dba Commeroe Comptlny 1 275.06
1201. ~ntaJSUJI\IItlN 135.00
al Flecordinlr of Deed . Commerce Land Title. Inc. dba Comrneroe Compllf1)' 45.00
b) RlCCIlllna of ~1lQll' ComIl1llCll Land Title. 100. db8 ~ eom""ny 90.00
1202. Supplemental SUII1marv 3.000.00
II County Deed Tax: SIllmp - Commen:e UI1d Tille. Inc. dba COnmerce Company 1,500.00 1,500.00
The following Section is res1lIlIId from lIIe SellIentent Statement Page 1
JOO. Cash At SeltlelMRt FRlm/To 80_
SOt. Gruu amountdu. from Eiorrower(Iin.I20)
JIl2, l$$$ IlllOunll; paid bytfor rrower (line 2201
-i.~;'-C~t'~~rom)'(".'fQfaorrcnw-r
600. Cash At liellIemenl To rom'Slnvr
601. Groll Amoullt dill 10 5llller (1lne 4~)
6ll1. Len redu~lioDS In amoUnts due to Seller ~Ine 520)
W. ash IX To)( From) SeU.r
1
I have carefully reviewed the HUD-l SellIement $laIement and 10 the besI of Illy knowledge and bell.f, it i$ II true and lCCurate oll18",*nl 01111 r_iplo and
distributions mad. on my ~c;ount or by I'M In ibis tl'ilnuQlion. I further certi1y Ibat I have re<;eived a copy oll11e HUD-1 Settlement SlalllfllOnL
SELLER(S):
JUN-26-2007 TUE 09:53AM 1D:
PAGE: 4
--.. . -,-
r.'. -.
A. Settlement Statement
U.S. Department of Housing
and Urban Development
~
-
~
,r
OMB Approval No. 2502-0265
~.
B. T 01 Loan
1. 0 FHA 2. 0 FmHA 3. 0 Conv. Unins.
4. 0 VA 5. 0 Conv. Ins.
6. File Number
7. lO&n Number
~. Mortgego InacnntO c... Numllor
5238
c:.. Note: This form Is furnished to give you a statement 01 actual settlement costs. Amounts paid to and by the settlement agent are
shown. Items marked -(p.o.c.)" were paid outside closing; they are shown here lor inlormational purposes and not
Included In the totals.
D. N....... and AddrwI at Borrower
- F.-t:i;n..nd Addresl of Lender
S\Xltl A. Parker and
Julie A. Parker
R. R. #2, Box 2200
9anton .
G. Proporty Location
TC# 16-117.00-012
Canton Township. Bradford County. Pennsylvania
! E. Namo ondAddro.. 01_
i Estate of Jayne C. Hartman
Steward H. Hartman, Executor
PA 17724
, Shiremanstown
PA
H. Se.IemO<1lIoqar<
Patrick J. Barrett Ill, Esquire
Piace of s.m.m.nt
17-21 Troy Street
Canton
PA
17724
- - l S.U1omanl Oate
4/1/2007
OI:U)U/'Hment Oat,
L.OI.: BlOCk:
J. Summary ot Borrower's Transaction
G Am to From BOlTower
K. Summary of Seller's Transaction
--..-. ---.' --_.-.--
400 Gros. Amount Duo To Soller
100. ro.. oun u. -
101. Contract sal.. orIce 58000.00 401. ColTIract .ales ~!ice . __.__~,000.00
'~--"\l
10Z. Per1IOfllllorocertv 40Z. Person.1 property ....._--
~03:' SelUement chl"'es 10 borrower (IIno 1400) 1 155.50 403. -. .-.
1~... ----- 404. - _nO -.. ~_ .. . ----.,--
lO,5. 405.
AdJustmonbJ lor It8ms cald bY nnor In advone. AdJU$lments for Items D.ld bv ..lIer In advanco 184.~8
1~,_ Clty/lown laxe. 4/112007 to 12/31/2007 184.08 406. Cltyltown taxe. 41112007 1012/3112007
,
107. County 10"'. to 407. County loxes \0 ..
1 O~. As....oment. to 40a. Assessments to ..-._- --
10.. School Taxes 41112007 to 6130/2007 124.47 409. School Taxes 4/~12007 _1~ 613012007 -. 1?4:.47
110. to 410. \0 .-....-..-..-.--
..
111. to 411. 10 - -----....
112.._ to 41Z. \0 .- --
113. to 413. ----~-- to
114. to 414. 10 --_.._'~
.1.15. to 415. 10 .--- .-
120. Oroo. Amount Ou. From Borrow.r 59,464.05 4Z0. Groas Amount Due To Sailor 58,308.55
I B 0 I 8 ""lfOfB
500RdctJ IA
to T S n
;00. Amounta Po d 'Y r n 0 orrow,r e u on$ n mO\lo UI 0 I er
201. Oeposltore.rn..lmon<IY . 5 000.00 501. Excosa dooo.it (see Inslrucllonsl .----s.OOO.OO
----
202. Prinelnalamounl or now loanr.l 502. 5elUement en.",... to .eller llino 1400\ __...___..~24.~1
203. Exi.ting Ioan(S) taken subject to ---- 503. Exlstlno !oen(s) I1Iken subject.!!!..... ------_.-
~fJ04. .. 504. Pavolfofftrst mortoaoe loan -_.~.... ..--.-
~Os. .- 505. Pavolf of .econd rnorllloo. loan ,
20ll. 506. . _.
I
207. . 507. --.-.. i
~~'''' 508. I ..
I
~09. 509. .. ....-- ---- _.j ..-.---
Adluotmanto for no.... unoalel bv seller Adjustments for It8mo uncald bY sener
~1.0. CI""lown taxes 10 SID. CiIvItoWll tax.. \0
nL CountY IlIxllS to 511. County taxes to
.-......- ..-- -
Z1 Z. Aasenm.nts 10 51Z. As.....m.nt. 10
..- .....
~13. to 513. to
-------, --
214. to 514. to
-.---.
215. to 515. I~
--.. ---..'.
21b. to 516. 10
-----..------...,. .. ... --.. .--
~)L.____. to 517. to
. .
ZlB. to 516. to
219. to 510. to
-
220. Total Paid By/For Borrower 5.000.00 5ZO. Total ReductJon Amount Duo Sonor 5.Cl24.32
~O. Caoh At Settl.mont From/To BOlTower
GOO. Cash At SeWem.nt ToIFrom Seller
.- 59,464.05 I -.---
301. OrossAmounl due lrom borrower CQno lZ0) 601. Groos omounl due to seller (line 4201 58,308.55
3!l~ LKs amounf paId bylfor borrower Oln& 220) 5000.00 002. leu reduction. In eml. due seller Wne 520) - !L.. . . M~~?->
303. Cooh l&l From o To Bor~r 54,464.05 &03. Cash l&l To o From SeHer I (--~2,464.23
- - .... -
"';;'...,
--/
SUBSTITUTE FORM 1099 SELLER STATEMENT
The ln1orml.Uon contained In Blocks E. G. H. and J and on Ilne ..01 (or, 110. -403 .0I;I404j 1$ Important tax InformaUon anOia being furnished to the Internal Revenue
So",I... If you ore requlnttd 10 liIe a return. . negligenoe penally or other &anctlon wlQ be Imposed on you If lhls ItBm ts roquifed to be reported and the IRS determln..
lhallt has not bsen reponed. U this roal "tall> Is your princlp.1 re.ldenee, tie Form 2119. Sale or Exchange of Principal Re.ldence. lor any gaIn. with your Income lax
return; lor other transaction.. cornpletelho epplicablo pa/1$ 01 Form 4797. Form 6232 and/or Schedulo D, Form 1040). You ara required 10 provid. the SeUlemenl AU,,"I
(named above) with YlllX correct taxpoyer Identlfic8don number. If you do nol provido the SelUernenl Agent with your correct taxpayor ldenllllcallon number. you may be
subject 10 eM or criminal pe""llies imposed by law. Undor penalties 01 po~ury. I ce<Ilfy thollh8 number allown on this slowment i. my correct laxpayer iderltlRcaUon number.
(SeUer's Signature)
RPR-2-2007 MON
10:30AM Tn:
O(Jr:::::c.':)
..,-.
. -,-
r-....
,=...l!oltlomont Chargo.
~OO. ]otal Solos/Broker's Comml$sion based on price $
Division.of. Commlnion (line 700) as {oIlows:
"701. 5 10
@
'loa
_..-=~
Paid From
Borrower's
Funds At
SalUement
Paid From
SeUers
Funds At
SeWemenl
702. S
703. Commis&ion paid at SelUement
704.
800. Items Payable In Connection With I.oan
B01. Loan Origination Fee
802. Loan Discount
B03. Appraioal Fee
B04. Cred~ Report
BO.~. Lender. Inspection Fee
B06. Mortgage Insurance Application Fee to
807. Assumption Fee
806.
809.
~~-_.._-_..
~1 1.
812.
813.
to
'"
%
to
to
'''~I
~O.:. Items Reouired By Lender To ae Paid In Advance Exclude last day In ca C$ . I ne 1 ~_..- ., . - ----.--
B01. Interest (rom 10 @S I day .. .-- -
902- Mortgage Insurance Premium for months 10 ..-- -- ..
903. Hazard Insurance Premium for years to _. _. ---- .-.-.
9.0~........_ .. yeats to ... .._--
905.
90
1 003. CI~..e!!!E!!3Y. Iaxes
1.004. County proPerly taxes
1005. Annual assessmenls
100B.
1000. Reserves Deposltod With Londer
1001. Hazan! Insurance 1
1002. Mortgage insurance 1
1
1
1
1
1
months@S
mon1hs@S
monthSllW
monthl@S
months@$
monthsl!ll$
monthsl!llS
J'.er month
per mon1h
per month
per month
per month
per month
per month
~....... ....... ......-...-.-....
.-.----..- -----.
,
.. -- - --.-
..--.-.-.... .. -- : .---------
1007.
1006. Aoareoate AccounUno Ad'uSlment
1100 Tltlo Chargea
'-'..--.--.-. --.-_. .
1101. Settlement or closing fee to '-'-. .. ....------..
1102. Abslract or tiUe .earch 10 - ... .. ..
1103. nUe examlnation to
1.l04. Tille Insurance binder to -..-.. .. ..
1105. Document preparation to ..
! lOB. Notary fees to ---""--
1107. Attorney's fees to Patrick J. Barrett III, Esquire ._ 50Q,QQ _.
(Includes above lIem. numbers: ) ..-....
1108. Trtle insuranC8 10
(Includes above Items numbers.: --. -. )
1109. Lendef. coverace S
1110. Owners coverage S -.---.-.-.
1111. ..~. -.--
11.1~. .--..-.
t1l3.
1200. Goyammanl Recording and Tronar.r Ch.~
47.00 : Mortgaoe $
580.00 : Mort!l!llo
580.00 : Mortgaoa
; Releases
47.00
_.~...!10.00
1201. Reconllng ra..: Deed $
.1202. Clly/county taxlstamrn: Deed $
1203. State taxlSlamrn: Deed 5
120.. Filing Clean & Green
1205.
1300 d' I I S III 1 Ch
I
f--
..28.50
?~q.OO
. A ditcna a emen argos ..-.-. .-..-.
1301. Survey to _.
1302. Pes! Inspect/on 10
. ..-...- ..-----
1303. Brenda Hartford-HiQley, Tax Collector - 2007 CountvfTownship Taxes ~_.- 244...32
130.. - .-- .. -.. - .
1305. --- .. .----- . -..
1306.
-/- -..,-
1307. ---..- - ..---.-.--
1308.
1400. Total SaWement Charga. (anter on IIn" 103, Secllon J and 502, Sactlon Kl 1 155.501 824.32
CERTIFICATION
~~ =~r ,:,,~,,:,di~:U~~~~~~:'1'tn:;:=rt;I~~I%.~ ~.=~~ '1' ~~~: :Mt'll~~~e~~~':~':n';;,~urala statamant of aU receipts and disbursements
Julie A. Parker
~ ~~d';rh~~'=~~ ~~~~ ~;t~:':w~~~t~T~;~C::sla~~.preparod It a tTve and ao;urate account of tho Juno., which were received anlj hive been or wUl
Seller
Scott A. Parker and
'_. __ ao~r
Sellar
Borrower
saWement Agent
___ Oat.
WARNING: III. a crtma 10 knowingly maka fa," atatemonts 10 the United S18le$ on this or 'rr{ other sImilar form. Penanl.s upon conviction can indude a fine and
i!npr1sonment. For delalli see; TWe 18 U.S. Code Section 1001 and Section 1010.
u.s. OOYflUIIOT ,RlNnNG Omcf: l"'H4C-lct
ODO_':l_':lDlDl7 Mn",
<tr::\_7l";\r\M Tn.
REV-1503 EX + (6-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hartman
Jayne
C.
FILE NUMBER
21 07
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0142
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION
Vanguard Group Account 09930978313, Prime Money Market Fund
VALUE AT DATE
OF DEATH
19,377.07
Vanguard Group Account 09930978313, Total Bond Market Index Inv.
64,246.28
Vanguard Group Account 09930978313, Wellesley Income Fund Inv.
66,213.56
946 Verizon Common @38.40
36,326.40
4062 AT&T @37.48
152,243.76
682 Comcast @ 25.69
17,520.58
475 aWest @8.16
3,876.00
50 NCR @46.92
2,346.00
72 AVAYA @ 12.77
919.44
586 Vodafone Air Touch @ 29.22
17,122.92
169 Lucent Technologies @ 12.87
2,175.03
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
382,367.04
REV-1508 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Hartman
Javne
FILE NUMBER
C. 21 07
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.
0142
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
24,744.83
PNC Bank Account # 7008-8629
2.
Cash
1,524.03
3.
Blue Cross- Refund
424.70
4
Blue Cross/BS/Blue Rx Refund
1,329.90
5.
Erie Insurance Refund
83.00
6.
Canton Township, Bradford County, Tax Refund
308.55
7.
Verizon - Dividend
383.13
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
28,798.14
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hartman
Jayne
C.
Debts of decedent must be reported on Schedule I.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
07
0142
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: 83.55
1. Auer Funeral Home, balance due on prepaid account
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Numbe~s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Yea~s) Commission Paid:
2. Attorney Fees John M. Eakin 17,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 524.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. The Cumberland Law Journal, estate notice 75.00
8. The Sentinel, estate notice 144.29
9. West Shore EMS 90.26
10. Central Penn Appraisal York Co. & 5 S. West Ave. 625.00
11. Radon Testing, 5 S. West Ave., Shiremanstown 780.00
12. Heritage Medical 56.68
13. Lawn Maintenance, Home Repairs, Labor, etc. - Eric Willhide and Jacob Murphy 780.00
14. Secco Home Plumbing, Home repair 481.85
15. Ritters Hardware, home repair 140.00
16. PNC Bank, check printing fee 16.99
17. Register of Wills, filing fee 15.00
18. Cost of Selling Real Estate, 1 % transfer tax 3,080.00
TOTAL (Also enter on line g, Recapitulation) $ 23 892.62
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hartman
FILE NUMBER
Jayne-
C.
21
07
0142
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Verizon, telephone
VALUE AT DATE
OF DEATH
130.45
2. Com cast, television
3. PA Water Company
4. Chase Credit Card
5. Cumberland County Office of Aging
6. Erie Insurance
7. PP&L, electric
8. Lower Allen Township, Sewer
9. US Treasure Federal Income Tax
10. Pa Income Tax
11. North East Waste Disposal
12. Tax Claim Bureau of York, delinquent taxes
235.20
141.61
1,146.91
48.90
390.00
570.97
32.00
221.00
517.00
32.61
957.27
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,423.92
'~~""".(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hartman
SCHEDULE J
BENEFICIARIES
Javne, C.
FILE NUMBER
21 07
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
0142
AMOUNT OR SHARE
OF ESTATE
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
3.
Steward Hartman
204 S. High Street
Mechanicsburg, PA 17055
Benjamin J. Hartman
PO Box 974
Camp Hill, PA 17011
Victoria Aronoff Hartman
6507 Wind mere Road
Harrisburg, PA 17111
Son
1/3 of net residue
1.
2.
Son
1/3 of net residue
Daughter
1/3 of net residue
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
-.
J1I'
LAST WILL AND TESTAMENT
OF
JAYNE C. HARTMAN
I, JAYNE C. HARTMAN, of the Borough of Shire mans town, County of
Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can be conveniently done.
2.
I direct that my entire estate be converted into cash and for this purpose, I hereby
authorize, empower and direct my Executors hereinafter named, to sell any and all real estate
which I may own at the time of my decease, as well as my personal property, at either public
or private sale or sales.
3.
After my estate has thus been converted into cash and upon the payment of all just
debts, costs of administration of my estate and the payment of all estate, inheritance and
succession taxes, I give, devise and bequeath my entire estate, then remaining, to my three
(3) children, to wit, my son, STEWARD H. HARTMAN, my son, J. BENJAMIN
- 1 -
HARTMANandDlY..
crORIA HARTMAN ARONOFF, share and share
alike, per stirpes.
LASTLY, I nominate, constitute and appoint my three (3) children, the
aforementioned, STEWARD H. BARTMAN, J. BENJAMIN HARTMAN and
VICTORIA BARTMAN ARONOFF, Co-Executors of this my Last Will and Testament
and direct that they be excused from posting bond or other security for the faithful
performance of their duties, in any jurisdiction.
-fA
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ - day of
September, A. D. 2005.
Q:..~/ e tJ~prJ(SEAL)
Ja C. Hartman
-_..",_..~~_,~.~7;~T~~,"";;:';;;;~ff.,'t~~~~~~t~~:-:--';~~',:y";-~'.~;.;~:"}i:'j}:,,,-..
-2-
..
*
COMMONWEALTH OF PENNSYL VANIA )
: SS
COUNTY OF CUMBERLAND )
I, JAYNE C. HARTMAN, the testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the same instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act and deed, for the purposes
therein expressed.
~ e ~EAL)
C. Hartman
Sworn and subscribed to before
me this P?'t day of September, 2005.
~~l- /11. '-/Jp PJ/Yv
Notary Public
NOTARIAL SEAL
HEIDI M. NELSON, Notary Public
Mechln~ Boro, Cumberfand Co.
My Commlssloi1 ExpIres June 27, 2007
COMMONWEALTH OF PENNSYL VANIA)
: SS
COUNTY OF CUMBERLAND )
We, the undersigned, J. ROBERT STAUFFER and JOHN M. EAKIN, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
JAYNE C. HARTMAN, sign and execute the instrument as her Last Will and Testament;
that the said testatrix executed it as her free and voluntary act for the purposes therein
expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as
witnesses; and that, to the best of our knowledge, the testatrix was, at the time, eighteen (18)
or more years of age, of sound mind, ~o constraint, duress or undue influence.
Sworn and subscribed to before
me this pH'! day of September, 2005.
l-{./r>~i- '--/17 -/J( i()f~
Notary Public
NOTARIAL SEAL
HEIDI M. NELSON, ~~Co
Mechank:sbulll Bora, UMlJUaIlRN .
My Commission ExpIreS June 27, 2007
- 3 -