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Home My WebLink About04-0020PETITION FOR PROBATE and GRANT OF LETTERS Estate of Ruby L. Hartmoyer No also known as To Register of Wtlls for the Deceased County of Cumberland tn the Soctal Securtty No 235-40-0174' Commonwealth of Pennsylvanta The pet~tlon of the undersigned respectfully represents that Your petlttoner(s), who ls/a,~g 18 years of age or older an the execu! rix named tn the last will of the above decedent, dated June 12 , 19 96 and codicil(s) dated Kenneth K. Hartmoyer, named Co-Executor renunced in favor of Deanna Owens, named Co-Executor Decendent was domlcded at death ~n Cumberland County, Pennsylvania, w~th ~llaSt family or prmclpal restdence at 1524 Sheepford Road, Lower Alien Township, and County, PA (hst street, number and munmpahty) Decendent, then 76 '~ years of age, died December 18, 2004 ,xlq~ at 1524 Sheepford Road', Meehanicsburg, Cumberland County, PA Except as follows, deceden(did not marry, was not divorced and dtd not have a chdd born or adopted after execunon of the wall offe(Md for probate, was not the v~cUm of a kllhng and was never adjudicated incompetent Decendent at death owned pi"_~'erty with esumated values as follows (If domlctled ~n Pa-), - .~,' ' All personal property $ 5,000.00 (If not domiciled In P~a )'~"'-..'Personal property in Pennsylvama $ (If not domtcded tn Pa ) Personal property tn County $ Value of real estate in Pennsylvanta $ sttuated as follows WHEREFORE, petitioner(s) respectfully request(s) the probate of the last wall and codicil(s) presented herewtth and the grant of letters testamentary (testamentary, admlmstrat~on c t a. admlmstracon d b n c t a ) theron Deanna Owens 187 Rose Hill Drive New Cumberland, PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF The petttlon~f~s~,~'~-fi~.~e,d~swear(s) or affirm(s)that the statements tn, t~he foregoing p.etttlon are true and correct't6 the best of me knowledge and behef of petttloner(s) ann that as personal represen- tative(s) of th6 above decedent petitioner(s) will well and truly admmtster the estate according to law Sworn to -or 'affirmed and subscrtbed beJk~re me this Estate of No. Ruby L. Hartmoyer , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ ~ ~ln conmderatlodof the petition on the reverse mde~reof, satisfact~ proof having been presented before me, IT IS DECREED that the instrument(s) date6 June 12, 1996 described therein be admitted to probate and filed of record as the last will of Ruby L. Hartmoyer and Letters Testamentary are hereby granted to Deanna Owens c FEES r--~, , Piob~ate, Letters, Etc $~--o~ Gerald J. Sh~k~'etskt 1~40486 Sho~ficates( ) $~ a~OR~EY'(Su~ dt ID No) Renunclatlon $ 414 Bridge St., New 'Cumberland, PA 17070 ~DD~SS TOTA~ $ ~ ~ & Ffle~ ~ ~ (717) 774-7435 '' PHONE ' ~ t' ' ' f / RENUNCIATION In Re Estate of Ruby L. Hartmoyer deceased To the Register of Wills of Cumberland County, Pennsylvania The undersigned son and named Co-Executor of the above decedent, hereby renounce(s) the right to adrmmster the estate and respectfully ask(s) that Letters Testamentary ~ be issued to Deanna Owens WITNESS my hand this 6th day of January ,xl~ 2004. KENNETH K. HARTMOYER (S~snature) (Address) (Signature) (Address) (Signature) (Address) I05 805 REV 9/86 Thru ~s to cerufy that the ~nformatJon here gJven ~s correctly cop~ed from an original ceruficate of death duly filed w~th me as Local Registrar The original ceruficate wdl be forwarded to the State V~tal Records Office for permanent fihng WARNING: It ~s illegal to duplicate th~s copy by photostat or photograph. Fee for th~s cernficate, $2 00 P 9812191 No Local Registrar OEC 2 2 2OO3 COMMONWEALTH OF PENNSYLVANIA * OEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH Ruby L. Hat tmoyer female J 235 -- 40 -- 0174 ' December 18, 2003 . : April 4, 76 ~ : : Milt Creek, Cumberland Lower Allen Twp. Dining Room Attendant Restaurant 1524 Sheepford Road Mechanicsbur PA 17055 Robert Gear 1524 Sheepford Road white [] 0 ,, Zonie Hammond Deanna L. Owens ~ 187 Rose Hill Drive~ New Cumberland~ PA 17070 c~.....O o~, ~,,.December 23, 2003 ~ndiantownGapNat'lC~metery;MHanover Twp., PA 17003 I [~[~NAT~N=~UNERALSERV~C~L'I~ENSEE~q~ER~rfIHGASsUCN IuC~NSEuu"s£R I"~e~n*nDRe~°~'u~ Parthemore FH & CS, Inc. ~, '~ ~1~ ~ ~/~ [~ Fl) 012 848 L I'~ P.O. Box 431, New Cumberland, PA 17070-0431 LAST WILL AND TESTAMENT OF RUBY L. HARTMOYER I, RUBY L. HARTMOYER, of Fairview Township, York County, Penn- sylvania, declare this to be my last will and revoke any will previ- ously made by me. ITEM I: I make the following specific bequests~ A. I bequeath the sum of Two Thousand and N0/100 ($2,000.00) Dollars to my daughter, PATRICIA JEAN PAP=RACK, provided she survives me. B. I bequeath the sum of One Thousand and NO/100 ($1,000.00) Dollars to my granddaughter, KRISTINA WAGNER, provided she survives me. C. I bequeath the sum of One Thousand and NO/100 ($1,000.00) Dollars to my grandson, KENNETH K. HARTMOYER, II, provided he survives me. D. I bequeath the sum of $1,000.00 to my granddaughter, KORTNEY HARTMOYER, provided she survives me. ITEM II: I devise and bequeath the residue of my estate, of every nature and wherever situate, as follows: A. Sixty (60%) percent thereof to my daughter, DEANNA OWENS. B. Forty (40%) percent thereof to my son, KENNETH K. HARTMOYER. Page 1 of 4 ITEM III: I hereby nominate, constitute and appoint my son, KENNETH K. HARTMOYER, as guardian for KORTNEY HARTMOYER who may take a share under this will. ITEM IV: I appoint DEANNA OWENS and KENNETE K. HARTMOYER Co- Executors of this my last will. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. I~ WIT~ESS WHE~OF, I, RUBY L. HARTMOYER, have hereunto set my hand and seal this ~ day of ~-Q~ , 1996. SIGNED, SE~X.mD, PUBLISHED and DECLARED by RUBY L. HARTMOYER, the Testatrix above named, as and for her Last will and Testament, and in the presence of us, who at her request, in her presence and in the presence of ea~lher, have subscribed our names as witnesses. AddreSs s Addre s s Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND : I, RUBY L. HARTMOYER, 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 this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~ RUBY L. HAR~OYER Sworn to or affirmed to and acknowledged before me by RUBY L. HARTMOYER, the Testatrix, this /~L day of ~ , 1996. Notary' ~uBlic COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : i NOTARIAL SEAL CONSTANCE L I(Ai~L, No~lry Public .N, ew~Cumb~da~l, I'A Cumberland Co ~Y cOmmlsslo~ Expires April 13, 1999 j 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 Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; Page 3 of 4 that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that tee eighteen or more years of age, of sound mind and under no constraint or undue influence. Witness ~ Sworn to or affixed to and ac~owledged before me by .~'~Ut~ ~, 3'~ and ~0~~ 1~¢~ witnesses, this ~& day of ~ , 1996. Page 4 of 4 IN THE COURT OF COMMON PLEAS, CUMBERLAND PENNSYLVANIA ORPHANS' COURT DIVISION COUNTY ESTATE OF ) / ) RUBY L HARTMOYER Deceased) Register' s # 21-2004-20 CLAIM To the Clerk of the Orphans' Court D~v~s~on : Index and make proper entry in your official records of the claim of CITIBANK(SOUTH DAKOTA)NA in the amount of 1,323.82 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) (2) The said decedent, whose last known residence was at 187 ROSE HILL DR NEW CUMBERLAND PA 17070 Written notice of this claim was given to JERRY SHEKLETSKI POB E NEW CUMBERRLAND PA 17070 on February 24, 2004 (Clalman~) SHAWN HARMER ,manager of Citicorp Credit Services, Inc. USA under limited power of attorney for CITIBANK (SOUTH DAKOTA) NA 1 7930 NW 110TM ST KANSAS CITY, MO 64153 (Claimant's Address) Account %(s) 4128002338034015 01/30/04 $1340.3Z $27.00 RUBY L HARTMOYER 187 ROSE HILL DR NEW CUMBERLAND 17070-2357000 PA SITE KC-CD P.O. BOX 8104 S HACKENSACK, Nd 07606'8104 TM'CD-5000 0z/0e/04 ACID:KCB2003 18.05.21: Citi* Platinum Select* Card 4128 0023 3803 4015 01/07/2004 $16400 $15059 $11100 $0.00 + $0.00 + 12/16 41693077 PAYMENT THANK YOU 70 0000 0 0 Standard Purch 1/07 PURCHASES*FINANCE CHARGE*PER)ODIC RATE 84 0000 0 1-800-950~114 I ~ CO BOX 6500 ~ . SIOUX FAELS.~.SD -O 57117 L3 r~ S11100 $27.00 = $27.00 -30.00 CASH WHEN YOU NEED IT - It's easier than ever to qet cash. up to your available Cash Advance Limit. Tear off the attached check~ deposit ~t ~nto your bank account, or use ~t l~ke any personal check Conventence Checks access the cash advance port,on of your credit hne. Refer to your C~t~bank Card Agreement for specific flnance charges YOU NAY QUALIFY FOR A SPEC[AL LOW BALANCE TRANSFER RATE AND OTHER CURRENT ACCOUNT DENEF[TS~ Loq onto http://balancetransfer accountonhne.com or call 1-800-950-5114 to find out more Protect your C3t] Card account today and receive a $15 retail rebate coupon to help with your expenses Call 1-866-647-9404 to f~nd out how to slqn up for opt3onal protect]on. Introducing Citl(R) Identity Theft Solutions [dent~ty theft can happen to anyone, [f it happens to you we can help with free spec~allzed assistance Wslt https.//www.cltlcards.com to learn more. 70000000000 Previous (+) Purchases (-) Payments (+) FINANCE (=) Ne~ Account Summary Balance & Advances & Credits CHARGE ~la~)~e PURCHASES $1.353 82 ~0.00 $30 00 $16 50 $1,3~0~32 ADVANCES $0 O0 :~0.00 $0 O0 $0 O0 TOTAL $1,353.82 0 O0 $30.00 $16.50 $1,3~1~.03} DaysThis BilUnc~ Period 30 Balance Sub~ect to Periodic Nominal ANNUAL Rate Summary Finance Charge Rate APR PERCENTAGE RATE PURCHASES Standard Purch $1,338 81 0.04107%(D) 14 990% 14.990% ADVANCES Standard Adv $0 00 0.05477%(0) 19 990% 19 990% SEND PAYMENTS TO 3 CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: Ruby L. Hartmoyer Date of Death: December 18, 2003 Wzll No. 21-04-0020 To the Register: I certmfy that notice of benefzcmal znterest requzred by Rule 5 6(a) of the Orphans' Court rules was served on or ma~led to the followmng benefmczarzes of the above captmoned estate on March 23, 2004. Patrzcma Jean Parrack (Deceased) Krlstzna Wagner 104 Mzlky Way Shlppensburg, PA 17257 Kenneth K. Hartmoyer, 719 Herman Avenue Lemoyne, PA 17043 II Kortney Hartmoyer 1524 Sheepford Road Mechanlcsburg, PA 17055 Deanna Owens 187 Rose Hzll Drzve New Cumberland, PA 17070 Kenneth K. Hartmoyer 1524 Sheepford Road Mechanzcsburg, PA 17055 Notzce has Rule 5 6(a) Date now been gzven to U'~-,O ~r, ,,)_~Ij,~;~C apa c z t y: all persons entztled thereto under "Gerald ~/. Shekletsk~, Esquire 414 Brmdge Street New Cumberland, PA 17070 717-774-7435 Personal Representatmve X Counsel for Personal Representatzve JAMES A. BALOGH - MN GARY W. BECKER - DC, FL, IL, MN, WI* *CREDITOR'S RIGHTS SPECIALIST AMERICAN BOARD OF CERTIFICATION CHELSEA A. WHITLEY- MN, WI ANGELA M. HORN - MN MICHAEL D, JOHNSON - MN MARY ELLEN WEEMAN - KS, MN, MO THERSIA O, LEE - MN CHAD J. BOLINSKE - MN STEVEN M, TOMS - MN MICHAEL L, MCCAIN - MN WILLIAM B. HOPKINS - MN, WI JOHN E, OLCHEFSKE - MN iON M, SUSTARICH - MN JASON R. FOSTER- MN MEAGAN M. PROBST - MN MICHAEL J. DOUGHERTY - MN REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 Re: BALOGH BECKER, LTD. ATTORNEYS AT LAW SEND ALL WRITTEN REPLIES TO: 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8440 FAX 763-852-8499 TOLL-FREE 877-768-4494 In the Estate of RUBY L HARTMOYER Probate Case No. /~21-04-20 ~ Social Security No: Last known residence: Our Client: Account Number: Amount of Debt: ARIZONA OFFICE: 64 E. BROADWAY ROAD SUITE 175 TEMPE, AZ 85282 DIANA THEOS - AZ, CO SANDRA TANG - AZ, CA OF COUNSEL: LITOW LAW OFFICES, P.C. (IOWA) LUSTIG, GLASER & WILSON, P.C. (MASSACHUSETTS) 04/14/04 187 ROSE HILL DR NEW CUMBERLND, PA 17070 CITIBANK USA, N.A. (SEARS ROEBUCK & CO) 1150156787493 $ 389.01 Dear Sir or Madam: Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll free at 1- 877-768-4494 Cordially, Balogh Becker, Ltd. Attorneys at Law Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. 4308 4/13/2004 1105303 COMMONWEALTH OF PENNSYLVANTA NOTICE OF CLAIM COURT OF COMMON PLEAS CUMBERLAND ,COUNTY ORPHANS' COURT D:[V]:STON Tn Re: The Estate of: RUBY L HARTMOYER Deceased Court File No: 21-04-20 TO: THE CLERK OF THE ORPHANS' COURT DTVTSTON: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.$.A. §3537(b)(2). CITIBANK USA, N.A. (SEARS ROEBUCK & CO) :~) Claimant's name: C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL 2) Claimant's address: HWY #200 MINNEAPOLIS, MN 55422 877-768-4494 3) Creditor listed below is the owner and holder of a claim in the amount of $. 389.01 4) 5) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. Decedent's address: 187 ROSE HILL DR NEW CUMBERLND, PA 17070 6) Date of Death: 12/18/03 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by - On behalf of the claimant, ! do solemnly declare and affirm under t enal s of perjury that they Information and representations made herein are;true and corre tODated.the best~_~_of -~'-~mY knowledge,,~p,~/~ information and be~ Chelsea A. Whitley/Angela M. Horn, Atto~.. Written notice of claim was given to Personal Representative and/o his/her.~.,-~nsel as stated below: DEANNA OWENS Name 187 ROSEVlLLE DR Address NEW CUMBERLAND, PA 10707 City/State,/ZiD Date notice mailed IN RE ESTATE OF: RUBY L HARTMOYER AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. The Decedent purchased merchandise in the amount of $ 389.01 account number 1150156787493 evidenced by The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not Subscribed and sworn before me This /~' day of ~ BALOGH B~, LTD. One of its attorneys: Chelsea A. Whitley __ Angela M. Horn ~ Michael D. Johnson __ Mary Ellen Weeman __ Thersia O. Lee Chad J. Bolinske No~b Public // ~ ~ STEP~NIE A, JOHNSON lJ (Ij'('a~l~ll))) NOTARY PUBLIC - MINNESOTA ¶ ~ HENNEPtN COUNTY ll My Commission Expires Jan. 31 2008 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 '"rD ,2004. REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUN~¢ CODE -- 2004 0020 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Hartmoyer, Ruby L 235-40-0174 LU DATE OF DEATH (MM-DD~YEAR) DATE OF BIRTH (MM-DD-YEAR THIS RETURN MUST BE FILED IN DUPUCATE WITH THE U.I 12/18/2003 04/04/1927 REGISTER OF WILLS III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER LU ~oo (3 n'_~ z rw E~ 1 Original Return E~ 4. Limited Estate [~ 6. Decedent Died Testate (Attach copy of Will) [~ 9. Litigation Proceeds Received E~ 2. Supplemental Return ~ 3 Remainder Return (date of death prior to 12-13-82) [~4a Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required [~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) 0 8. Total Number of Safe Deposit Boxes ~ 1 0. Spousal Poverty Credit (date of death between 12-31-91 an~ 1-1-95) r'~ 11. Election to tax under Sec. 9113(A)(Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL cORREsPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS NAME Gerald J. Shekletski, Esq. FIRM NAME (If Applicable) Stone, Lafaver & Shekletski TELEPHONE NUMBER (717) 774-7435 414 Bridge St. P.O. Box E New Cumberland, PA ~,~70 1 Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4 Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6 Jointly Owned Property (Schedule F) (6) [--'~ Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1 0. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) 1 1. Total Deductions (total Lines 9 & 10) 1 2. Net Value of Estate (Line 8 minus Line 11) 1 3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 0.00 0.00 0.00 0.00 7,460.80 2,514.74 0.00 (8) OFFICIAL USE ONLY 9,975.55 10,053.00 3,271.77 (11) 13,324.77 (3,349.23) 0.00 (3,349.23) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 1 5. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 1 7. Amount of Line 14 taxable at sibling rate 1 8. Amount of Line 14 taxable at collateral rate. 19. Tax Due 20. x .0 (15) x .0 __ (16) x .12 (17) x .15 (18) (19) > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W4645 1.000 Decedent's Complete Address: STREET ADDRESS 1524 Sheepfored Road Cl~ Mechanicsburg STATE ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 0.00 0.00 0.00 Total Credits (A + B + C) (1) (2) Total Interest/Penalty (D + E) (3) 0.00 0.00 0,00 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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) A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5B) 0.00 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; ....................... [----] b. retain the right to designate who shall use the property transferred or its income; ......... [---] c. retain a reversionary interest; or ................................ ~ 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? ............................ E~] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? E~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ E~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, 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 pre~3arer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE (~ F'ERSON RESPONSIBLE FOB FILING RETURN /DATE /. ADDRESS 187 Rose Hill Road New Cumber~an_d, PA 17070 New Cumberland, PA 17070 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 3% [72 P.S. § 99t6 (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 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use ora natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (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. 2W4646 1.000 LAST WILL AND TESTAMENT OF RUBY L. HARTMOYER I, RUBY L. HARTMOYER, of Fairview Township, York County, Penn- sylvania, declare this to be my last will and revoke any will previ- ously made by me. ITEM I: I make the following specific bequests: A. I bequeath the sum of Two Thousand and NO/100 ($2,000.00) Dollars to my daughter, PATRICIA JEAN PARRACK, provided she survives me. B. I bequeath the sum of One Thousand and NO/100 ($1,000.00) Dollars to my granddaughter, KRISTINA WAGNER, provided she survives me. C. I bequeath the sum of One Thousand and N0/100 ($1,000.00) Dollars to my grandson, KENNETH K. HARTMOYER, II, provided he survives me. D. I bequeath the sum of $1,000.00 to my granddaughter, KORTNEY HARTMOYER, provided she survives me. ITEM II: I devise and bequeath the residue of my estate, of every nature and wherever situate, as follows: A. Sixty (60%) percent thereof to my daughter, DEANNA OWENS. HARTMOYER. B. Forty (40%) percent thereof to my son, KENNETH K. Page 1 of 4 ITEM III: I hereby nominate, constitute and appoint my son, KENNETH K. HARTMOYER, as guardian for KORTNEY HARTMOYER who may take a share under this will. ITEM IV: I appoint DEANNA OWENS and KENNETH K. HARTMOYER Co- Executors of this my last will. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. IN WITNESS WHEREOF, I, RUBY L. HARTMOYER, have hereunto set my hand and seal this /~+~ day of ~U~ , 1996. ~USf L. SIGNED, SE~?.~.D, P~BLISHED and DECLARED by RUBY L. HARTMOYER, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the Addre s s Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND : I, RUBY L. HARTMOYER, 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 this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the p~rposes therein contained. RUBY h. Sworn to or affirmed to and acknowledged before me by RUBY L. HARTMOYER, the Testatrix, this ~.~L day of ~ , 1996. Notary' ~u~lic COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : 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 Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it aS her free and voluntary act for the purposes therein expressed; Page 3 of 4 that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~_~J witneWs Wi'~ness Sworn to or affirmed to and acknowledged before me by _~,~,:~A~ (.2 . -PT'D,,~. and ~D ~ ~ ~, j~IC ~Co~ /2~ day of ~q,~ , 1996. / ~' Notary Public witnesses, this Page 4 of 4 REV~1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF Hartmoyer, Ruby L FILENUMBER 21-2004-0020 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 2 3 4 DESCRIPTION Members 1st Federal Credit Union Regular savings Account 237308-00 1995 Oldsmobile Achieva automobile VIN IG3NL55M6SM316228, Title Number 48235467002HA, sold January 21, 2004, to Charles E. Watts and Sarah M. Watts for $2,000.00. State farm Mutual Automibile Insurance Refund. 2003 federal income tax return refund TOTAL (Also enter on line 5, Recapitulation) $ VALUE AT DATE OF DEATH 4,715.39 2,000.00 52.41 693.00 7,460.80 2W46AD 2.000 (If more space is needed, insed additional sheets of the same size) MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 237308 -00 11/04/2003 $4,712.84 $2.55 $4,715.39 None MI~IVl, BERS'-'c" lST FEDERAL CREDIT UNION 'Denise A. Wolfe 6/ Insurance Supervisor January 16, 2004 Estate of: RUBY I. HARTMOYER Date of Death: 12/18/2003 Social Security Number: 235-40-0174 5000 Louise Drive · P.O. Box40 · Mechanicsburg, Pennsylvania 17055 · (717)697-1161 ° www. memberslst.org REVelS09 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Hartmoyer, Ruby L 21-2004-0020 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Owens, Deanna Daughter B Hartmoyer, Kenneth K 187 Rose Hill Road New Cumberland, PA 17070 1524 Sheepford Road Mechanicsburg, PA 17055 Son JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % Of DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A 04/01/1974 PNC Bank Checking Account 1,174.50 50.00 587.25 #5140027187 2 B 08/14/1996 PNC Bank Checking Account 3,854.99 50.00 1,927.49 #5130048865 TOTAL (Also enter on line 6, Recapitulation) $ 2,514.74 2W46AE 2.000 (If more space is needed, insert additional sheets of same size) MAR-D1-2004 19:14 PNCBANK 412 ?68 3458 PNCBAN March 2,2004 Gerald J. Shekletski 414 Bridge Street P.O. Box E New Cumberland, PA 17070 Estate of Ruby L. I-Iartmoyer, deceased SSN: 23540-0174 DOD: 12/18/2003 Dear Mr. Shetletski: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Accounts Account #5140027187 RUBY L HARTMOY'F_~ DEANNA L OWENS DOD balance: $1,174.50 (non-interest bearing) Established 04/01/1974 Account #5130048865 RUBY L HARTMOYER KENNETH K I-tARTMOYER DOD balance: $3,584.86 ~- $. 13 accrued interest Established 08/14/1996 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Rachelle Wells 1-800-762-1775 PT-PFSC-04-F 500 first Ave. Pittsburgh PA 15219 Member FDIC TOTAL P.01 REV-15'~ EX + ('f-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hartmoyer, Ruby L 21-2004-0020 Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. DESCRIPTION fUNERAL EXPENSES: Parthemore Funeral Home and Cremation Services, Inc. ADMINISTRATIVE COSTS: Personat Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Name: Gerald J. Shekletski, Esq. 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Long Enterprises - preparation returns Oppenheimer Funds Services of final income tax TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 9,100.00 0.00 750.00 0.00 58.00 0.00 0.00 75.00 70.00 10,053.00 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV*1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Hartmoyer, Ruby L 21-2004-0020 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Sears credit card account #1150156787493 Sears credit card account #5121070160680001 Citibank credit card account #4128002338034015 QVC credit card account #17393139351 Value City credit card account #5856370727465834 PNC Bank credit card account #4264297967378883 Boscov's credit card account'#003260178 AT & T Verizon AMOUNT 389.01 830 45 1,323 82 64 91 115 43 67 96 465 73 6 63 7 83 TOTAL (Also enter on line 10, Recapitulation) $ 3,271.77 2W46AH 2000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Hartmoyer, Ruby L NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTW TAXABLEDISTRIBUTIONS[includeoutrightspousaldistributions, andtransfers under Sec. 9116(a)(12)] Owens, Deanna 187 Rose Hill Road ~ew Cumberland, PA 17070 Hartmoyer II, Kenneth K 1524 Sheepford Rd. Mechanicsburg, PA 17055 Parrack, Patricia J. Predeceased Decedent Wagner, Kristina 104 Milky Way Shippensburg, PA 17257 Hartmoyer, Kortney 1524 Sheepford Rd. Mechanicsburg, PA 17055 FILE NUMBER 21-2004-002, RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Son Grandchild Grandchild Grandchild AMOUNT OR SHARE OF ESTATE 60% of Residue 40% of Residue $1,000.00 $1,000.00 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0 2W46AI 1.000 (if more space is needed, insert additional sheets of the same size) Estate of: Hartmoyer, Ruby L Schedule J Part 1 -- Beneficiaries Page 2 21-2004-0020 Item No. Name and Address of Person(s) receiving property Relationship Amount or Share of Estate Hartmoyer, Kenneth K 1524 Sheepford Road Mechanicsburg, PA 17055 Son $1,000.00 COMMONWEAL?N COUNTY OF SS: Deanna Owens sworn being duly accordina fo law, deposes and says thats he __j .~_the Executrix ' of +he 5state of Ruby L. Hartmoyer Iate of ---Lower-Allen-T-ownsh~p Cumberland County, Pa., d ' eceasea and that the within is an inventory made by Deanna Owe_ns , the sa[d of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwea'fn of ?ennsyJvania. and that the figures opposite each '~= cf the Inventory represent it's fair value ~ : , Jl~m as of the date of :]ec~aents death. and subscribed before me, E~ecufor . AO'm;ni~frafor Deanna Owens Adclres~ New--Cumh~inland~A 17070 Date of Death 18 December 2003 Day Month Year INSTRUCTIONS !. .An inventory .must be f'iea wifhln three months after appointment of personal represenfaHve. 2. A :uppiemenf ~nventary must be filed within fhirfy days of discovery of additional assets. -'.. Aaa,~,ona~ :hee+~ ma,/ be attached as to personalty or reatfy 4. See Art[cie iV. Fiduciaries Act of 1949. CD Inventory of the real and personal estate of Ruby L. Hartmoyer deceased REAL ESTATE NONE PERSONAL PROPERTY 1. Members 1st Federal Credit Union Regular SaVings Account 9237308-00 2. 1995 Oldsmobile Achieva automobile VIN IGNL55M6SM316228 Titie Number 48235467002HA State Farm Mutual Automobile Insurance Refund 2003 federal income tax refund TOTAL REAL ESTATE AND PERSONAL PROPERTY ! .$ 2,00i-~ !}$ 52.4! iS 6931. 0¢ !iS 7,460 8¢ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ruby L. Hartmoyer Date of Death: December 18, 2003 Will No. 2004-00020 To the Register: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: Yes 1. State whether administration of the estate is complete: X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes No X (b) The separate Orphans' Court No. (if any) for the personal representative,s account is: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes X No (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' report. Date: ~~/~/ ~W Capacity: Court an~/~e attached ~ ' eraldCI<'. Shekletski, Esquire 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Personal Representative X Counsel for Personal Representative est\rel\lform.rel IN RE: ESTATE OF RUBY L. HARTMOYER, LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : No. 2004-00020 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, KENNETH K. HARTMOYER II, being one of the beneficiaries under the will of RUBY L. HARTMOYER, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RUBY L. HARTMOYER, in full satisfac- tion and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, KENNETH K. HARTMOYER II, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. ~IN WITNESS WHE/r- ~OF,~/I~e hereunto set my hand and seal the day of ~// ~ . , 2004. Witness KENNETH K. HART~K~ER II COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : ,\ on t h s, , me a Notary Public, the undersigned o~icer, personally appeared KENNETH K. HARTMOYER II, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WIT~SS ~E~OF, I have hereto set my~and and seal the day and year first above written. ~~~_ Notary Public C~~ ~ ~V~ NOTAR~L S~ ~ROL L. TROXELL, N0~ PublE I N~ Cum~ Bom. Cumbar~nd Co. I ~ ~mm~s~lo~ ~p~r~ ~e% 27, ~51 est\rel\lform.rel IN RE: ESTATE OF RUBY L. HARTMOYER, LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION : No. 2004-00020 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, DEANNA OWENS, being one of the beneficiaries under the will of RUBY L. HARTMOYER, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RUBY L. HARTMOYER, in full satisfaction and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, DEANNA OWENS, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. IN WITNESS WHEREOF,~_.~I have hereunto set my hand and seal the day of ~,7~_~/- , 2004. Witness DEANNA OWENS COMMONWEALTH OF PENNSYLVANIA: : COUNTY OF CUMBERLAND : SS: me a Notary Public, the undersigned officer,' personally appeared DEANNA OWENS, 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 purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. COMMC~WEALll-I OF NOTARIAL SEAL KATHLEEN KEIM, Notary Public New Cumberland Boro. Cumberland My, Commisrdon Expires Dec. 5. est\rel\lform.rel IN RE: ESTATE OF RUBY L. HARTMOYER, LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION : No. 2004-00020 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, KRISTINA WAGNER n/k/a KRISTINA DEUTSCH being one of the beneficiaries under the will of RUBY L. HARTMOYER, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RUBY L. HARTMOYER, in full satisfaction and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, KRISTINA WAGNER n/k/a KRISTINA DEUTSSCH, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of /~'~ , 2004. Witness COMMONWEALTH OF PENNSYLVANIA: : COUNTY OF CUMBERLAND : KRISTINA WAGNER n/k/a KRISTINA DEUTSCH SS: On this, the tJ day of ~.~~ , 2004, before me a Notary Public, the undersigned offider, personally appeared KRISTINA WAGNER n/k/a KRISTINA DEUTSCH, 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 pur- poses therein contained. IN WITNESS WHEREOF, I have and year first above written. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL KATHLEEN KEIM, Notary Public New Cumberland Boro. Cumberland Co. ~ Commission F.x~ms ~,c. 5. 200e hereunto set my hand,a~ seal the day Notary ~b~i~ est\rel\lform.rel IN RE: ESTATE OF RUBY L. HARTMOYER, LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : No. 2004-00020 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, KENNETH K. HARTMOYER, legal guardian of KO~TNEY HARTMOYER, being one of the beneficiaries under the will of RUBY L. HARTMOYER, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RUBY L. HARTMOYER, in full satisfaction and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, KENNETH K. HARTMOYER, legal guardian for K~TNEY HARTMOYER, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and as- signs, from the acts of the Executrix as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. ~__IN~, day'ITNESSof ~-RE//~OF,~.%.~ I have hereunto, 2004. set my hand and seal the Witness COMMONWEALTH OF PENNSYLVANIA: KENNETH K. HARTMOYER, legal guardian for K~TNEY HARTMOYER SS: COUNTY OF CUMBERLAND /7 : #~,.~,.--a _~ this, the ~ day of ~'~~' , 2004, before On me a Notary Public, the undersigned offi~e{j personally appeared KENNETH K. HARTMOYER, legal guardian for KOiRTNEY HARTMOYER , known to me (or satisfactorily proven) to be the person whose name is sub- scribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have and year first above written. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL KATHLEEN KEIM, Notary Public New Cumberland Boro. Cumberland Co. My Comm~lon Expires Dec. 5. 2006 hereunto set my hand/~s ~ar yP~l~,~ eal the day est\relllform.rel IN RE: ESTATE OF RUBY L. HARTMOYER, LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION NO. 2004-00020 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, KENNETH K. HARTMOYER, being one of the beneficiaries under the will of RUBY L. HARTMOYER, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of RUBY L. HARTMOYER, in full satisfac- tion and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, KENNETH K. HARTMOYER, do by these presents, remise, release, quitclaim and forever discharge the Executrix, her heirs, successors and assigns, from the acts of the Executrix as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executrix. IN WITNESS~6HEREOF, I have hereunto set my hand and seal the day of //~?~.~/ , 2004. Witness COMMONWEALTH OF PENNSYLVANIA: : KENNETH K. HARTMOYER SS: COUNTY OF CUMBERLAND : On this, the C~ ~ day of ~~ 2004, before me a Notary Public, the undersigned off=~=~,. F=zoonall~ appeared KENNETH K. HARTMOYER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have and year first above written. COf4/VlON~ OF PENNSYLVANIA NOTARIAL SEAL KATHLEEN KEIM, Notary Public New Cumberland Boro. Cumberland Co. I MY Commission Expires Dec. 5. 2006 hereunto set my hand/e~ seal the day Notary P~~ BUREAU OF INDTVTDUAL TAXES I'NHERTTANCE TAX D~'VTSTON DEPT. Z80601 HARRTSBURG, PA 17ZZ8-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-IS47 EX AFP (01*OS) GERALD J SHEKLETSKI ESQ STONE ETAL PO BOX E NEW CUMBERLAND PA 17070 DATE 07-Z6-ZOOfi ESTATE OF HARTNOYER DATE OF DEATH 12-18-2003 FZLE NUNBER 21 04-0020 COUNTY CUNBERLAND ACN 101 Amoun~ Remi~ced RUBY L HAKE CHECK PAYABLE AND RENTT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HARTNOYER RUIIY L FILE NO. 21 04-OOZO ACN 101 DATE 07-26-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1 2 3 6 7 8. ORIGTNAL RETURN Real Es~a~e (Schedule A) (1) S~ocks and Bonds (Schedule B) Closely Held S*ock/Par~nership Tn*eres~ (Schedule C) (3) Nor~cgages/NoJ:es Receivable (Schedule D) Cash/Bank Deposi~cs/Misc. Personal Proper~cy (Schedule E) (5) Jointly Owned Proper*y (Schedule F) (6) Transfers (Schedule G) (7) To':al Asse~:s APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule 11. 12. 15. NOTE: ASSESSHENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~e 16. Amoun~ of Line 1~ ~axable a* Lineal/Class A ra~e 17. Amoun~ of L/ne 1~ 18. Amoun* of LAne 1~ ~axable a* Collateral/Class B ra*e 19. PrAncApal Tax Due TAX CREDITS: PAYMENT RECEIPT D/$COUNT DATE NUMBER INTEREST/PEN PAID (-) .00 .00 .00 .00 7;460.80 2;514.74 .00 NOTE: To insure proper cradi~ ~o your account, submi~ ~ha upper portion of ~his form wL~h your ~ax payment. (8) 9,975.55 (9) (10) $. ,~,7~': 7 7 ~ ~;~ To'l:al Doduc'l:lons CT 'i: (11) =i~:~324.77 Ne~ Value of Tax Rs~urn Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule d)~;~ (15)~ .... ~;; . O0 ~e~ W~ue of Es~e SuU~ec~ ~o T~x ~' [~)~ 73~5~9.25- I~ an assessment ~as lssued pPevlously, 11nes 1~, 15 and/~ ~16, ~ 18 ~ 19 ~ill Pe~lect ~i~uPes that lnclude the total o~ ALL PetuPns asses~d (is) . oo . oo (16) .00 x 045= .00 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= . O0 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any futurm interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, tho Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futurm interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Net[ce and submit with your payment to the Register of Nills printed on the reverse side. --Hake check ar money order payable to: REGISTER OF gILLS, AGENT A refund of a tax credit, which was not requested on the Tax Rmturn, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of the Register of Hills, any of the Z$ Revenue District Offices, or by calling the special Z~-hour answering service for fores ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-4~7-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 1?lIB-lOll, OR --election to have the matter determined at audit cf the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sma page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the decedmnt's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, tho first day after the end of tho tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date cf death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six CSX) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 19BZ will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lOX .O005~B ~'~-X991 Ill .O0050X ~ 9Z .000247 1983 16Z .000438 199Z 92 .O00Z~7 ZOOZ 6Z .000164 1984 llX .000301 1993-199~ 72 .000192 2003 5Z .000137 1985 13Z .000556 1995-1998 9Z .O00Z~7 ZOO~ 4Z .000110 1986 IOZ .000Z7~ 1999 7Z .00019Z 1987 iOZ .OOOZ?4 ZOOO 7Z .OO019Z --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELTNQUENT X DAZEY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on tho Notice, additional interest must bm calculated. March 10, 2004 ESTATE OF: RUBY HARTMOYER DECEASED ( NO. 21-2004-20 ( IN THE PROBATE COURT: (CUMBERLAND PA RECEIPT AND RELEASE The undersigned hereby acknowledges receipt of payment and complete satisfaction of the lien previously filed in this cause of action by CITIBANK (SOUTH DAKOTA), N.A., Tax ID #13-2665911, for Account Number(s) 4128002338034015. This is also a RELEASE of the Estate and all persons acting for or on behalf of such Estate with respect to any and all claims or demands which the undersigned may have with respect to the Estate of any of its assets. CITIBANK (SOUTH DAKOTA),N.A. STATE OF MISSOURI COUNTY OF PLATTE SHAWN HARMER Manager for CiticorpCredit Services, Inc(USA) under limited power of attorney for Citibank (South Dakota) N.A. This instrument was acknowledged before me on March 10, 2004, by SHAWN HARMER of CITIBANK (SOUTH DAKOTA), N.A., in said capacity and on behalf of said corporation. otary P~blic, Stt~ of Missouri SHE/L£y R. BAKER t'lotary ?ub[ic - ~otary Seat Sta~ of t'l~ssouri Clay Cnm~tv . ~Y Comm,>sm] [xp~res 5spt. 6. 2006