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Home My WebLink About09-07-07 --.J 15056041147 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 OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN 21 01 RESIDENT DECEDENT File Number C) (SL) Date of Birth 172249488 02052007 05271932 Decedent's Last Name SHARTZER Suffix SR. Decedent's First Name KENNETH MI R (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 X 1 Original Return r---- L 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4 Limited Estate u 4a. Future Interest Compromise (date of death after 12-12-82) x 6 Decedent Died Testate (Attach Copy of Will) D 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10 Spousal Poverty Credit (date of death . between 12-31-91 and 1-1-95) 11.Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EARL RICHARD ETZWEILER 7172345600 ~.. ..... Firm Name (If Applicable) ETZWEILER AND ASSOCIATES .; ("""J REGISTER OF WILl.S..,USE ONLY . , First line of address 105 NORTH FRONT STREET Second line of address -1 City or Post Office HARRISBURG State PA ZIP Code 17101 DATE FILED L', Correspondent's e-mail address:REtzweiler@Comcast.net Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowled e. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE Kenneth R. Shartzer Jr. Earl Richard Etzweiler ADDRESS , 105 North Front Street, Harrisburg, PA 17101 L Side 1 15056041147 15056041147 --.J ~ 15056042148 REV-1500 EX Decedent's Social Security Number 172249488 Decedent's Name: Kenneth R. Shartzer Sr. RECAPITULATION 1. Real Estate (Schedule A)..................................................................................... 1. 295,000.00 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. 21,464.26 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested............. 7. 8. Total Gross Assets (total Lines 1-7~.................................................................. 8. 316,464.26 36 , 067 .'25 17,144.98 53,212.23 263,252.03 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, of transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line -i4"ia'Xable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 263,252.03 o . 0 0 15. o .00 16. 11,846.34 17. o .00 18. o . 0 0 19. 11,846.34 263,252.03 o .00 19. Tax Due.................... ................... ............. ..... ..... ................. ....... .............. ........... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. D Side2 L 15056042148 15056042148 ~ REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Kenneth R. Shartzer Sr. STREET ADDRESS 4616 Old Gettysburg Road File Number 21 .. CITY I STATE PA !IZIP 17055 Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 11,846.34 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (3) (4) (5) (5A) (5B) 11,846.34 11,846.34 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: a. retain the use or income of the property transferred;.............................m............................................ b. retain the right to designate who shall use the property transferred or its income;................................ c. retain a reversionary interest; m........................................................................................................... d. receive the promise for life of either payments, benefits or care?........................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?...... ............. ...... .... ......... ..... ........ ............ ......... ..... .... ............. ......... ... ...... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death:?....... D 'x' 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?................................................................................................................ D L!J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No D ~.lCj D x. " U x n . X. L...J .~ 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. 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 statutedoes not exemDta 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) *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. FILE NUMBER 21-- ESTATE OF All real property owned solely or as a tenant In common must be reported at fair market valuliair 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 jolntly-owned with right of survivorship must be disclosed on schedule F, ITEM NUMBER DESCRIPTION 1 Real Estate known as 4616 Old Gettysburg Road, Camp Hill, Lower Allen Township, Cumberland County, Pennsylvania, being three tracts of land identified as two tax parcels -Tax Parcel Nos. 13-24-0795-104 and 13-24-0795-103, described in Cumberland County Record Book 278, Page 2033 and Deed Book Q, Vol. 32, Page 360, sold for $295,000.00. VALUE AT DATE OF DEATH 295,000.00 TOTAL (Also enter on Line 1, Recapitulation) 295,000.00 (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 A (Rev. 6-98) t , F".....iouS IIIdihons are obsolele form HUO-' (3/B6) fsl Handbook '130~_] A Settlement Statement U.S. Department of Housing and Urban Development B. Tvoe of Loan OMS Aooroval No. 2502-0265 (exoires 9/30/20061 1. DFHA 2. DFmHA 3. DConv. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number 4. nVA 5. neonv. Ins. 286960LDGEmSB C. Note: lIe~1 o=;~~I~~~~.row~:: ~ ~:~i:~;:I~::lhS:yn~~",:~\Se::~~:~!;:O~ ~~el..~~"~~~~l ~d~:dlll:lh~tah. I TitleExpress Settlemenl Syslem WARN~NG: It II . crime 10 knoWIngly r:nake '.1'11 elelemll.nls 10 the United StIIles on Ihls or any olher I.lmUar form. Penalties upon con"icllon can Include II fll1tll!tnd !rT.c,isonl"MlnL FDf ditta/Is IlIe: TltI. 18 U. S. Code Seclion 1001 and Section 1010 Prinled 06/13/2007 at 10:26 CLT D NAME OF BORROWER: OLD GEmSBURG ASSOCIATES, VI, L.P. ADDRESS: c/o Select Caoltal (cj). 4718 Old Gettvsbura Road, Mechanicsbura. PA 17055 E. NAME OF SELLER: THE ESTATE OF KENNETH R. SHARTZER ADDRESS: F. NAME OF LENDER: Community Banks ADDRESS: 55 Wetzel Drive Hanover Pa 17331 G. PROPERTY ADDRESS: 4616 Old Gettysburg Road, Camp Hill, PA 17011 Lower Allen Township H. SETTLEMENT AGENT: Cedar Cliff Abstract Agency, Inc., Telephone: 717-774-7435 Fax: 717-774.3869 PLACE OF SETTLEMENT: 414 Bridae Street New Cumberland PA 17070 I. SETTLEMENT DATE: 06/1312007 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contracl sales mice 295 000.00 401. Contract sales price 295,00~,Q! 102. Personal Prooertv 402. Personal Prooertv 103 Settlemenl charoes 10 borrower lline 1400\ 5 968.50 403. 104. 404. 105 405. Ad'ustmenls for items oaid bv seller in advance Ad'ustments for items oaid by sellerin advance 106. Cilv/lown laxes 406. Citv/town taxes 107. Counlv taxes 06/131071012/31/07 294.95 407. Countv taxes 061131071012/31/07 294.95 108. School taxes 06/13/071006/30107 53.46 408. School taxes 06/13/071006130/07 53.46 109. 409. 110. SewerlTrash 06/13/07 to 06/30/07 16.34 410. SewerlTrash 06/13/071006/30107 16.34 11,. 411, - 112 412. 120. GROSS AMOUNT DUE FROM BORROWER 301 333.25 420. GROSS AMOUNT DUE TO SELLER -.- 29~4.7~ 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER -- 201. Deoosil or earnesl monev 501. Excess Deposit (see instructions) Settlement charQes to seller (line 14001 -.- 202. Amounl of Loan $560 000.00 502. 535.61 Existino loanfsltaken subieclto 503. Existina loanlsltaken subjecl to ---- 203. 204. 504. Payoff of First Mortoaoe Loan 205. Loan Advance 295 000.00 50S. Communitv Banks 206. 506. 207. 507. 20B. 508. 209. 509. Adiustments for items unoaid bv seller Adiustments for items unpaid bv seller 210. Citv/town laxes 510. Cilyllown taxes -- 21 I. Countv laxes 511. County taxes 212. Schoollaxes 512. School taxes 213. 513. 214. 514. ----- 215. 515. '--'- 216. 516. _-0- 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 295 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 535.~.1. 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENTTO OR FROM SELLER 301. Gross amounl due from borrower (line 120\ 301 333.25 601. Gross amount due 10 seller (line 420) 2.9~364,75 302. Less amounts oaid bvl'or borrower (line 220) 295 000.00 602. Less reduction amount due seller (line 520) 535.61 '- 303. CASH FROM BORROWER 6 333.25 603. CASH TO SELLER ~29.14 SUBSTITUTE FORM 1099 SELLER 5T ATEMENT: The Informalion conlained herein is important la): inlotmahon and is being lumished 101m, Inlemal Rel/Bnue Service. "YOLl are requirod to file B relurn. .. negligence panall)! Of olhar sanction will b.lmpostld on you if Ihi& itam is required 10 be repol1ed and theiRS delermill85 thallI has nol been reported. The Contract Sal8s PrICe desCflbed on hne .01 above constitul., (he Gran Proceeds of lhis transaction You .'e reQUired by law 10 provide the nn~ment egenl (Fed. Till 10 No: )wilh your .corrllct181payer Idenllficalion number, If you do no! provide your corrflcllolCP3Y.f idenlrficltion number, you may be subject 10 clvN or ctlmmal penalllelllmposed by 18w. Under penaltllls 01 perjury, I certify thallhe number shown on Ihis s!atementlS my corncl !alCpayelldenhrlcalion numbel. TIN: _0___'___._ SELLER(S)SIGNATURE(S)' SEllER(S) NEW MAILING ADDRESS: SElLER{S} PHONE. NUMBERS: (HI (w) PrevIOus edtlionl. Hre obsolele lorm HUD-1 (3186) ref Handbook -4305.2 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT File Number. 2B6960LDGETTYSB PAGE 2 TItleExoress Selllement System Printed 06/13/2007 a110:26 CL T L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based Dn nrice $295 000.00 = BORROWER'S SELLER'S DivisiDn of commission (line 700) as follows: FUNDS AT FUNDS AT 701. $ to SETTLEMENT SETTLEMENT 702. $ 10 703. CDmmission paid al Seltlement 704. Commission/Escrow DeoDsit to Howard Hanna Real Estate Services IP.O.C.110 000,00 Buver BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioinalion Fee % 802. Loan Discounl % 803. Aooraisal Fee 804. Credil ReDDrt 805. Lende~s InsoectiDn Fee 806. Mortoaoe Application Fee 807. Assumolion Fee 808. 809. 810. 81,. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Inlerest From to (.ij /day 902. Mortoaoe Insurance Premium fDr to 903. Hazard Insurance Premium for tD 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. Iii> $ /mo 1002. Mortoaoe Insurance mD. (ci) $ ImD 1003. City Prooertv Tax mo. (ci) $ lmo 1004. Countv Prooertv Tax mo. Iii> $ 44.63 Imp 1005. School taxes mo. Iii> $ 95.66 Imo 1009. Aooreoate Analvsis Adiustmenl 0.00 0.00 1100. TITLE CHARGES 1101. Settlement Dr closinn fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Preoaration 1106. NotaTV Fees 1107. AttDmey's fees (includes above items ND: ) 1108. Title Insurance tD Cedar Cliff Abstract Aoencv. Inc. (includes abDve items No: I 1109. Lenders PDlicy 111 O. Owne~s PDlicy 1111. 1112. 1113. 1200, GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordina Fees Deed $ 38.50 . MortnaDe $ . Release $ 38.50 1202. City/County tax/slamDs Deed $2 950.00 . Mortnane $ 2 950.00 1203. Stale Tax/stamos Deed $2 950.00 . MDrtDaDe $ 2 950.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1302. Pest Insoection 1303. Tax Cert Fees tD Stone Lafaver & Shekletski 30.00 1304. 2007 CDuntv Taxes-Tracl #1 tD Bonnie K. Miller' 92.12 1305. 2007 County Taxes-Tract #2 10 Bonnie K. Miller' 443.49 1400. TOTAL SETTLEMENT CHARGES lenter on lines 103 Section J and 502 Section Kl 5 968.50 535.61 HUD CERTIFICATION OF BUYER AND SELLER I of my knowledge and belief, it Is a true and accurale slalement of all receipts and disbursements made on my account " a copy of lhe HUD.' Seltlement SralBrnenl. '~<f ~M~$~I~.H.i,~^?r '6' fi'"\(.v( WARNING; IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT, FOR DETAILS SEE T1TLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENT AGENT: DATf&k) Rev-1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. FILE NUMBER 21-- ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Old Gettysburg Associates, VI, L.P., reimbursement for 2006-07 School taxes from 6/13/07 - 6/30/07 VALUE AT DATE OF DEATH 53.46 2 Old Gettysburg Associates, VI, L.P., reimbursement for 2007 CountylTownship taxes from 6/13/07 - 12/31/07 294.95 3 Old Gettysburg Associates, VI, L.P., reimbursement for sewer/trash from 6/13/07- 6/30/07 16.34 4 PNC Bank Checking Account #5140257572 - Date of death value $2,687.01 2.687.01 5 1985 Cortez Boat and Trailer - appraised for $1,987.50 1.987.50 6 2 MAU 20 Custom 270 gun, appraised for $250.00 250.00 7 2004 Ford F150Truck, appraised at $15,725.00 15.725.00 8 Colt Python 357 gun - appraised for $350.00 350.00 9 Ithaca 37 16-gauge gun - appraised for $100.00 100.00 TOTAL (Also enter on Line 5, Recapitulation) 21.464.26 (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) JUN~27-2007 22:46 PNCBANK 412 768 3458 P.01/01 o PNCBAN< June 26, 2007 Earl Richard EtzWeiler 105 North Front Street Harrisburg, PA 17101-1436 RE: Estate of Kenneth R. Shartzer, Sr., deceased SSN: 172-24~948S 000: 2/5/2007 Dear Mr. Etzweiler: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5140257572 Established 05/01/1980 KENNETH R SHAR TZER,SR DOD balance: $2,686.93 + $.08 accrued interest Interest Paid 1/1/2007 - 2/S/2007 - $.11 The decedent maintained Investment Account (INV #82141924). For further information. you may contact the Brokerage Department at 1-800-762-6111. Please note that this office only provides date of death balances for deposit accounts (TRAs, CDs, Checking and Savings accounts). We do Dot process any financial transactions or provide statements. If you need assistance with any of these items, please call1-8g8-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, c?1(lQ)1tLtl Wllk- RacheJle Wells }-800-762-1775 P7-PFSC-04-F 500 first Ave. Pittsburgh P A 15219 Member FDIC TOTAL P.01 ADOS ~Blue Book- Robbins Marine ~(? ~ IOriginal M.S.R.P. Wholesale Low Wholesale High Retail $3,570.00 $470.00 $760.00 $960.00 Mfg: Grumman by OMC Year: 1985 Model:Cortez Notes: Condition: Fair Condition Adjustment: -25% Trailer: 18 Trailer Year:1985 Trailer Axles: 1 Outboard Motor(s): 1 1987 Mariner by Mercury Marine 90ELO Fresh water pricing Boat Type BB Overall Length 17' 8" Beam 73" Weight 620 Trans. Height 20" Max HP 90 Hull Alum. Load Capacity 1632 QRtjgn(31 Eq~lp_ment Original Cost . J:~aQl:l/R~sale $0.00 0 $0.00 .~g~ o Value $0.00 $0.00 $4,799.00 $510.00 $1,080.00 $1,330.00 Trailer .A..91usted Book Value $1,305.00 $9,674.00 $155.00 $851.25 $285.00 dtr::\ 75 $360.00 $1 ,987.~ M.S.R.P. Low High Retail BQok V~lueC::;OIlQition_6Qlustment Optional Equ!Q.rTlent $3,570.00 $0.00 $470.00 ($283.75) $0.00 $760.00 ($531.25) $0.00 $960.00 ($662.50) $0.00 Outboard Motor -. . J L__ hDr'\CI6\ ~Io,..trnnir M::uine Blue Book@ 2007 Model Year Fall/Winter Edition. 2/22/2001 709 Cloverleaf Road, Elizabethtown, PA 17022 , I Phone: (717) 367-5585 · Fax: (717) 367-9493 TROP Web site: www.tropgunshop.com E-mail: info@tropgunshop.com h Hours: Mon. - Fri. 9-9 Sat. 9-5 gun 5 Op Name lL.e.>-\ ~~"1't-\ Ia-. ~ ~.J'L jrL. Address r ~f'~ (.-...A.-- DkP 5 Er-VN-. S. County Customer Phone Date o Cash o Check o Charge o Layaway o Gift Certificate r I i :-: --r"t'\ ~ }7 100 I' (p 7!9- v . ~ 2-Y)' ~~Lf 2- ov1 0 tJ 10 Gu.S---r'O M L~ --0 .- '2-70 '~ ?g~?~ 2 0:> v'r-- {J i'-f 'f:-u ~v\ .3 5"0 -- -/ 757 " crt 3-oe-E ,00 - RECEIVED BY HC!!J!!!~ FORDlAND (717) 657-1aoc:o HARRISBURG, PA 17112 FAX (717) 657-9791 www.hoffmanford.com ESTABLISHED 1953 ~,..~ rr?" ""[l["'T" ~ej" '->;\',,:'.-<rfb . ~ ~O~;j;j}{(((~}~ 4!IiiP 7!lZ-{07 .--c; !J ~1 O"^ ; t M """j 'L~tL fOvJ FlS;O Co", C '-€"" '11"'\ ' , ~~~ 0.. 0La..d/'--. P.:>-o 0 ~ s --r '!.... \i i tJ It j f "( R.x. i <f W LfY- Ai C (O ,().. <-f \/c<-lo-<:.- ~ 111 S 7 2..S" - . -r k~:, (-(f~v",h ~ {)..(.;kl G..-,.\... \lq,LJ-L o{' ~ ~0e. r 1- ~ :,>soV"\.e ::> ....lic..J · 10," 'i. ".r C\.. d~ +-.+1 e. (Z.e ~ -r' c.+0 \ \. '1 ({<<\.vv ~ (3.,..:h1.<>Y tJe<.l& /,AIIPAo.y '\ ~~ REV-1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-- ESTATE OF ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 10,632.65 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Kenneth R. Shartzer Jr. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 1740 Hunter Lane City Dauphin State PA Zip 17018 - Year(s) Commission paid 12,491.30 2. Attorney's Fees Earl Richard Etzweiler 12,491.30 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 302.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 150.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 36,067.25 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. FILE NUMBER 21-- ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Fackler & Wiedman - funeral expense 10.632.65 Subtotal 10.632.65 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) ~ -+ ackler-Wiedeman V FUNERAL HOME Dennis L. Wiedeman, FD. - President James W. Taljan. F.D. - Supervisor William A. Sibert, F.D. STATEMENT February 23, 2007 Mr. Kenneth R. Shartzer, Jr. 1740 Hunter Lane Dauphin, PA 17018 The Funeral Service of: Mr. Kenneth R. Shartzer, Sr. !.~.. CH.L\.RGE FOR SERVICES SEL~CTED: I . 1. PROFESSIONAL SERVICES 2630.00 $ 2. FACILlTIES/SERVICES/EQUIPMENT:$ 730.00 3. AUTOMOTIVE EQUIPMENT: 695.00 $ (A) TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE lB. CHARGE FOR MERCHANDISE SELECTED: I Casket. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 3500.00 (Description) Stainless Steel Gasketed $ 4055.00 Outer Receptacle . . . . . . . . . . $ (Description) Concrete/Polystyrene 1195.00 Outer burial container. . . . . . . . . . . . . . . . . .. $ (Description) Acknowledgement Cards ............... $ Register Book(s). . . . . . . . . . . . . . . . . . . . . .. $ Memory Folders. . . . . . . . . . . . . . . . . . . . . .. $ Prayer Cards. . ., ..................... $ Temporary grave marker. . . . . . . . . . . . . . .. $ Burial Clothing ........................ $ Other Clothing. . .. . . . . . . . . . . . . . . . . . . . .. $ custom Graphic uesign & Priminy ........ ~ Flowers .~q~k.e.t .$prfiY.-+: Tfi!<. . . . . . . . . . . .. $ $ $ Cremation Urn . . . . . . . . . . . . . . . . . . . . . . . . . $ Interior & Exterior Crucifixes ............. $ Refrigeration. . . . . . . . . . . . . . . . . . . . . . . . .. $ -0- -0- -0- -0- -0- -0- -0- -0- -v- 318.00 -0- -0- -0- -0- (B) TOTAL MERCHANDISE SELECTED $ 5013.00 PAID IN FULL RECEIVED 4/9/07 ESTATE CHECK NO. 1004 .~~. dJ~ ~ ~(t'::n e d and 23rd and Derry Streets . Harrisburg. PA. 17104 Phone: 717.564.1434 Fax: 717.564.7274 email: wiedemanfh@comcast.net www.wiedemanfuneralhome.com o F ACCOUNT I C. SPECIAL CHARGES: I Forwarding of remains to (Funeral Home) Receiving of remains from $ -0- $ $ $ $ (Funeral Home) Immediate Burial Direct Cremation SUB-TOTAL OF SPECIAL CHARGES. . . . . . . . . . I D. CASH ADVANCES: Opening Grave. . . . . . . . . . . . . . . . . . .. $ Cemetery Equipment. . . . . . . . . . . . . . . . $ Newspaper Notices - Local. . . . . . . . .. $ Newspaper Notices - Out-of-town. ... $ Telephone & Telegrams. . . . . . . . . . . . . $ Airfare. . . . . . . . . . . . . . . . . . . . . . . . .. $ Clergy Honorarium. . . . . . . . . . . . . . . . . $ Pallbearers. . . . . . . . . . . . . . . . . . . . . . . $ Certified Copies of Death Certificate. .. $ Crematory Charges. . . . . . . . . . . . . . . . . $ Organist. . . . . . . . . . . . . . . . . . . . . . . . . $ SOl0ist Other Other Other SUB-TOTAL OF CASH ADVANCES -0- -0- -0- -0- C$ -0- '" '" I 1105.00 137.80 161.85 -0- -0- -0- 100.00 -0- 60.00 -0- -0- -0- -0- -0- -0- $ $ $ ........0$ 1564.65 SUMMARY OF CHARGES: A. Professional Services, Facilities and Equipment and Automotive Equipment. . . . . . . . . . . . . . . . . . . . . . . $ B. Merchandise.................,... $ C. Special Charges. . . . . . . . . . . . . . . . .. $ D. Cash Advances. . . . . . . . . . . . . . . .. $ 4055.00 5013.00 -0- 1564.65 TOTAL OF ALL SELECTIONS .................. $ 10632.65 LESS PAYMENTS.RECElVED . . . . . . . . . . . . . . . . . $ BALANCE DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Operarea....we Care 0.00 10632.65 Rev-1502 EX+ (6-98) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. IFILE NUMBER 21-- ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - advertise Letters 75.00 2 Etzweiler & Associates - photocopies, postage, notary fees, etc. 25.00 3 West Shore News 50.00 Subtotal 150.00 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 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. FILE NUMBER 21-- ESTATE OF Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 ABC Fuel Oil Co. - fuel oil VALUE AT DATE OF DEATH 109.73 2 American Homepatient, oxygen bill 31.79 3 Balogh, Becker, L TO, Sears Credit card 320.55 4 Bank of America - credit card payment 739.06 5 Bon Ton, credit card payment 50.00 6 Bonnie Miller, Tax Collector - 2007 Countyrrownship taxes 535.61 7 Cummings Associates - co-pay on medical office visit 75.14 8 Discover Card - credit card payment 296.04 9 Ford Motor Credit - payment on truck loan 643.34 10 Ford Motor Credit - payment on truck loan 315.24 11 Ford Motor Credit - payoff loan on truck 10.846.91 12 Ford Motor Credit - truck payment 328.10 13 Ford Motor Credit - truck payment 328.10 14 Geico, truck insurance 141.66 15 Justin Price, 40 hours of time to clean out house 400.00 16 Kim Weiser, 50 hours of time to clean out house 500.00 17 Lower Allen Township, sewer and trash payment 87.50 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 17,144.98 (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-1512 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shartzer, Kenneth R. Sr. IFILE NUMBER 21-- ESTATE OF ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 Omnium Worldwide, HSBC credit card payment 366.85 19 PPL Electric Company - electric bill 27.49 20 PPL Electric Utilities - electric bill 102.55 21 PPL Electric Utilities - electric bill 35.58 22 PPL Electric Utilities - final electric bill 12.74 23 Top Water Marine Inc. - trash removal 348.86 24 U-Haul, move personal property 352.58 25 U-Haul, move personal property 80.13 26 Verizon - telephone bill 69.43 TOTAL (Also enter on Line 10, Recapitulation) 17.144.98 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule I (Rev. 6-98) 06/14/2007 12:34 Ford Credit Document ID: cscvru2-80511 Page: 1 '- Ford Credit [_"'J Loan Payoff Quotation Fax Confinnation Payoff Quotation Da1C: 06/14/07 AGcoullt Number. 37224429 vebicle Yutm:l Make-: 2004 LJat PaymerJt .A.tm11Dt Received: 315.24 vdicl.e. 1D (V'IN): 1FTRX 14 W 4 4NC 1 04 2 4 0a.1e ReaiYI:d: 06/08/07 Next PaymcJ:lt Due Ode; 07/12/07 ~axoff pa~ Good- T.brcugh Da1lC; R'lfr U~ nnr r T 06/24/07 Nofe.: FwIds.... ... reeeMcI .. ....otfk:leo.. or tbt .. ..od-fJnug.... .... AJrDwt of Pa~!I: 10846.91 Please send your payoff to: Ford Credit PO BOlt 790119 St I..cuis> Mo 63119-0119 PJ_ pe I)is" k:t l.bit JlH=08 al<<auslQII: It's been a pleasure to serve you. We hope you'll remember us for your "Db 1 future automotive financing needs. {J C7 ,. h ~-\ ~ eJ-} '\;f:J \' Jc C lJ-> ~ or dD V- " 'd.S~' ~\d.\ Customer Service Center 1.....12,. ..,.. MaDd&y-Sat'Ulday 7:(J) &.m.-3:00 p.m. C www.It.lrdcRdK.cGm. ~~y (_\\qlo't ~0 w c)G*-' \\) REV 1513 EX+ (9-1l0) *' SCHEDULE ~ BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Shartzer, Kenneth R. Sr. 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-- ESTATE OF RELATIONSHIP TO DECEDENT Do Not List Trustee(sl SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. 1 James C. Shartzer 283 N.E. 31 st Street Boca Raton, FL 33431 Son 1/2 of Residue of Estate 2 Kenneth R. Shartzer Jr. 1740 Hunter Lane Dauphin, PA 17018 Son 1/2 of Residue of Estate Total 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 TOTAL OF PART 11_ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)