HomeMy WebLinkAbout08-06-0815056041147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes ~
Po BOx.28o601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 • RESIDENT DECEDENT 21 0 7 0 9 31
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
198 18 7594 09 29 2007
Decedent's Last Name
ARTZ
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
Date of Birth
02 24 1925
Suffix Decedent's First Name MI
ROBERT E
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~I 5. Federal Estate Ta;c Return Required
(date of death after 12-12-82)
n B Decedent Died Testate
,, ~~,, ^ ~ Decedent Maintained a Living Trust 8. Total Number Of Safe Deposi4 Boxes
~~ (Attach Copy of Wilp (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 1 p, 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 tVumber
JEFFREY B. ENGLE 717 692 2345
Ftrm Name (If Applicable)
SFlAFFER & ENGLE LAW OFFICES
First line of address
129. MARKET STREET
Second line of address
City or Post Office
MILLERSBURG
State ZIP Code
PA 17061
Correspondent'se-mail address: Jeff@Shaff.erengle.COm
,.,
..,
DATE FlI.ED ~ -
~.:~: , .
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 Vue, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer h;as any knowledge.
SIGNAT S RESP NSIBLE FOR FILING RETURN DATE
~ ~~~~~ Kim W. Artz Mr. i~~///T iI
/{DDRESS
2326 Herb
SIGNATURE I
Inrc Fu rrn DA 47AQ4
1505641147
1505604114'7
-J f 1
51de 1
15D56D42148
REV-1500 EX
Decedent's Social Security Number
Decedenrs Name. R o b ert E. A rtz 1 9 8 1 8 7 5 9 4
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... ... 1.
2. Stocks and Bonds (Schedule B) ............................................................................ ... 2. 1 ~~ 2, 0 8 3. 3 8
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. 9 4 , 2 5 9 . 7 0
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ........... .. 6. 3 , 6 2 4 3 5
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ........... .. 7.
8. Total Gross Assets (total Lines 1-7) ..................................................................... .. 8. 2 3 9, 9 6 7. 4 3
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .. 9. ]- 8 , 6 3 6 . 0 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 9 1 9 . 8 2
11. Total Deductions (total Lines 9 & 10) ................................................................... ... 11. ~. 9 , 5 5 5 8 9
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 2 t: 0 , 4 1 1 5 4
13. Charitable and Governmental Bequests/Sec 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. 2 [. 0 , 4 1 1 5 4
TAX COMPUTATION m 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 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 2 2 0, 4 1 1. 5 4 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18.
19, Tax Due .................................................. .................................................................. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
0,00
9,918.52
0,00
0.00
9,918.52
Side 2
15D56042148 15D56042148
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 2007-00931
DECEDENT'S NAME
Robert E. Artz _
STREET ADDRESS
418 Wren Court
CITY STATE i ZIP
Mechanicsburg I PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
g. Prior Payments
C Discount
8,000.00
421 .05
(1) 9,918.52
Total Credits (A + B + C) (2) 8,421.05
3. Interest/Penalty if applicable
p, Interest 4.31
E. Penalty
Total Interest/Penalty (D + E) (3) 4.31
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1 , 501.7 8
A Enter the interest on the tax due. (5A;
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 1 5 01 .7
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 :.................................................................................
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? ......................................................... .. ~ ,f X 1
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?......... ~ '~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ;~
contains a beneficiary designation? ...................................................................................................................... Imo' ~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.
n _.,., .~ _.. <. - ._ ,-
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not 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. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5 i percent,
except as noted in 72 P.S. §9116 1.2) (72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blo~~d or adoption.
Rev1503 EX+ (6-98)
SCHEDULE B
~~ STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Artz, Robert E. 2007-00!331
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 2,189.969 shares of Financial Network -Bond Fund of 13.2500 29,017.09
America Class C
2 451.265 shares of Financial Network -Capital Income 66.6200 30,063.27
Builder Class C
3 1,391.308 shares of Financial Network -Income Fund 21.0900 29,342.69
of America Class C
4 Franklin High Income Class C 2.76 16,116.37
5 Franklin Income Class C 2.09 37,543.96
TOTAL (Also enter on Line 2, Recapitulation) I 142,083.38
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150(1 Schedule B (Rev. 6-98)
Rev-1508 EX+(8.98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Artz, Robert E. 2007-00931
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Comcast Cable -Refund 49.65
2 Community Banks Checking - 135135616 -DOD Balance 7.197.02
Accrued interest on Item 2 through date of death 5.89
3 Community Banks - Ctf of Dep - 335188467 -Matures 2/3/2008 10,000.00
Accrued interest on Item 3 through date of death 40.05
4 Community Banks - Ctf of Dep - 335188468 -Matures 2/3/2008 10,000.00
Accrued interest on Item 4 through date of death 40.05
5 Community Banks - Ctf of Dep - 335188469 -Matures 2/3!2008 10,000.00
Accrued interest on Item 5 through date of death 40.05
6 Community Banks - Ctf of Dep - 335188470 -Matures 2!312008 5,000.00
Accrued interest on Item 6 through date of death 20.03
7 Community Banks - Ctf of Dep - 335188491 -Matures 2/10/2008 10,581.37
Accrued interest on Item 7 through date of death 31.78
8 Financial Network -Income Fund of America Class C 127.11
9 Highmark -Refund 144.20
10 Nationwide Insurance -Refund on Homeowners Insurance 16.65
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 5, Recapitulation) 94,259.70
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1508 EX+ (8.98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
'~. PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA continue d
INHERITANCE TAX RETJRN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Artz, Robert E. 2007-00'931
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150D Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-981
s SCHEDULE F
CDMMCNWEA~TH DF RENN3YLVAN~A JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMI3ER
Artz, Robert E. 2007-00931
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 RELATIOI~SHIP TO DECEDENT
A. Kim Artz 2326 Herb Road Son
Temple, PA 19560
B
C
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
LETTER
FOR JOINT
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OI'
DECC'3
INTERS=~T DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A 12/28/81 M&T Bank -Checking -DOD Balance 7,248.51 50.000% 3,624.26
2 A 12/28/81 M&T Bank -Checking 0.17 50.000% 0.09
TOTAL (Also enter on Line 6, Recapitulation) 3,624.35
(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 F (Rev. 6-98)
REV-1151 EX+ (12.99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Artz, Robert E. 2007-00931
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Kim W. Artz Mr.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 2326 Herb Road
City Temple state PA zip 19560
Year(s) Commission paid 2007-5,000. 2008-1,500
548.62
6,500.00
2, Attorney's Fees Shaffer 8~ Engle Law Offices 6,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 371.00
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 4,716.45
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 18,636.07
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150D Schedule H (Rev, 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-A
~~ FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Artz, Robert E. 2007-00!31
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 :schedule H-A (Rev. 6-98)
Rev-1502 EX+(6-98)
SCHEDULE H-B4
~~ _ PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TFV( RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Artz, Robert E. 2007-00!331
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-64 (Rev. 6-98)
Rev1502 EX+ t6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Artz, Robert E.
FILE NUMIBER
2007-00931
ITEM
NUMBER
DESCRIPTION
AMOUNT
1 Cumberland County Law Journal -Legal Advertisement 75.00
2 Custer, Faust 8~ Associates, P.C. - 2007 Individual Income Tax Returns 85.00
3 Doris Lori -looked after and assisted in showing mobile mobile until sale was 500.00
complete, etc.
4 Gus Yatron Mail Facility 5.25
5 Joe Stielman -Haul Junk from 418 Wren Court 200.00
6 Leffler Energy 727,88
7 M&T Bank -Estate Checking -Service Charge 14.00
8 Nationwide Insurance -Homeowners Insurance 87.28
9 Nationwide Insurance -Homeowners Insurance 97.29
10 Post Master of Berks 24.45
11 Postage 6.17
12 PPL Electric -Electric Service 42.33
13 PPL Electric -Electric Service 57.94
14 PPL Electric -Electric Service 35.33
15 PPL Electric -Electric Service 24.96
16 PPL Electric -Electric Service 24.00
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98)
Rev-1502 EX+ (6-9S)
~. SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
c o n ti n u e
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Artz, Robert E. 2007-00931
ITEM
NUMBER DESCRIPTION AMOUNT
17 PPL Electric -Electric Service 17.19
18 PPL Electric -Electric Service 22.51
19 Register of Wills -Filing Fee - REV -1500 15.00
20 Register of Wills -Fee for Filing Releases 25.00
21 Register of Wills -Filing Fee -Inventory 15.00
22 Register of Wills -Short Form Certificate 4.00
23 Register of Wills -Short Form Certificates 20.00
24 Reserve - Tax/Tax Preparation etc. 500.00
25 Richland Partner Cash Transfer 110.00
26 RVG Mgtr -Final water bill 13.50
27 The Sentinel -Legal Advertisement 166.60
28 Verizon -Final Telephone Bill 25.18
29 Village Associates (Rent 8~ Water at 418 Wren Court, Mechanicsburg, Pa) 342.07
30 Village Associates (Rent & Water at 418 Wren Court, Mechanicsburg, Pa) 341.50
31 Village Associates (Rent 8~ Water at 418 Wren Court, Mechanicsburg, Pa) 342.07
32 Village Associates (Rent & Water at 418 Wren Court, Mechanicsburg, Pa) 343.50
33 Village Associates (Rent & Water at 418 Wren Court, Mechanicsburg, Pa) 343.50
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-B7
•= OTHER
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN c o n ti n u e
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Artz, Robert E. 2007-00'931
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98)
Rev-1512 EX+(6-98)
~. ' -
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF (FILE NUMBER
Artz, Robert E. 2007-00'931
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Clem Ciccarelli MD -Medical Services Rendered 106.00
2 PA Dept of Revenue -Income Tax for 2007 20.00
3 PPL Electric -Auto transaction after DOD 72.89
4 Quantum Imaging -Medical Services Rendered 36.00
5 Quantum Imaging -Medical Services Rendered 214.00
6 Village Associates (Rent & Water at 418 Wren Court, Mechanicsburg, Pa) -Check 377.71
written prior to DOD
7 West Shore EMS -Ambulance 61.30
8 West Shore Pathology -Medical Services Rendered 31.92
TOTAL (Also enter on Line 10, Recapitulation) ~ 919.82
(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)
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Robert E. Artz 09/29/2007 198-18-7594
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
Jamey E. Artz Granddaughter
2523 Eisenhower Court
West Lawn, PA 19609
2 Kim W. Artz Son
2326 Herb Road
Temple, PA 19560
Travis C. Artz Grandson
2554 Grant Street
4 Vanessa Engle Granddaughter
101 Apple Valley Circle
Clarks Summit, PA 18411
~~~ 3i11 ~zt~ C~ ~~t~zrt~zz
I, ROBERT E. ARTZ, of Mechanic.:~urg, Cumberland
County, Pennsylvania, being of sound and disposi_.g mind, memory and
understanding, hereby declare this instrument to be my .Last Will
and Testament, revoking any and all Wills by ,..a heretofore made.
IT'~1I. I direct my hereinafter-named E. acutor or Executrix,
to pay all my just debts, funeral expen.-es and administration
expenses, ir:ciuding inheritance tares, as soon: as may be convenient
after my decease.
ITEM II. I gi ve : _ _-
A. My diamond ring with three stones (i Karat) fo-my_•son~
KIM W. ARTZ; and, -
B. My set cf two anniversary bards (1 Karat) to my sen-, KIM
W. ARTZ; and, ••
C. ldy green water pitcher and five glasses to my scn, KIM W.
D. '~?y pi;,k water Hitcher and glasses to my son, KIM W. ARTZ;
ar,d,
~. My wile, Helen's, diamond watch to my granddauchter,
VP.NESSA ENGLE; and,
F. !v'y wife, Helen's, diamond engagement ring (1 Karat) to my
^randdaughter, VANESSA ENGiE; and,
G. I~rs. Fielder's cut glass pitcher to my granddaughter,
VANESSA ANGLE; and,
H. Iv'y set of Naritoka China to my granddaughter, VANESSA
ENGLE; and,
I. M_y Kimball Organ to my grandson, TRAVIS C. ARTZ; and,
J. 1~?y automobile to my grandson, TRAVIS C. ARTZ; and,
K. 1~'y mother of pearl jewelry bcx to my granddaughter, JAMEY
ARTZ; and,
L. My anniversary clock to my granddaughter, JAMEY P~2TZ;
Gnd,
M. My opal ring to my granddauahter, JAMEY ARTZ; and,
N. My Ba_'dwin Brass candle sticks to my granddaughter, JAMEY
ART2.
!~
~/ ~ _~ ~ - L ~~ (SEAL)
Page 1 of 2 Paces R~rt E. Artz ~^
ITEM III. A11 the rest, residue and remainder of my Estate,
real, personal or mixed, of whatsoever nature and wheresoever
situate, I give as follows:
A. SOo unto my son, KIM W. P.RTZ, or his issue per stirpes;
and,
B, y0a unto my granddaughter, VANESSA ENGLE, or her issue
per stirpes; and,
C, i5o unto my grandson, TRAVIS ARTZ, or his issue per
stirpes; and,
D, ~% unto my granddaughter, JAMEY ARTZ, or her issue per
stirpes.
ITED4 IV. I hereby ..^.ominate, constitute and appcint my son, KIM
vW. ARTZ, as Executor of this, my Last Wi11 and Testament. In the
event he is enable to act ir, this capacity, then my granddaughter,
VANESSA ENGLE, sha11 serve in his stead.
IT.~ y, I d_:rect that my Executor or Executrix shall not be
reovired to give bond for the faithful performance of their duties
in this or any ether jurisdiction.
IT~4 VI. _My Executer or Executrix, is hereby authorized and
empowered to se11 at pu.h,lic or private sale or sales all of the
personal property of w.nich I may die seized and to likewise sell
all real estate of which I may die seized and to convey the same by
fee simple deed or deeds to the same effect that I could personally
do, if 1iv:ng.
IN WIaNESS WHO ~ECF, I hereunto set my hand and seal to th i s my
Last Wi11 and Testament, consi~"~ing off' two (2} typewritten page,
bear;ng mY signature this~~~daY ofi~(-~/~ A. D., ZOC2.
Y
SIGNED IN
-~L~c~ rr 'LL' ~ GL'~ (SEAL)
Robert E, Artz ~
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF DAUPHIN
Before me, the undersigned authority, on this day
personally appeared
TESTATOR: ROBERT E. ARTZ
WITNESS: JEFFREY B. ENGLE
WITNESS: ANGELA A. KOHLER
known to me to be the Testator and the Witnesses, respectively,
whose names are subscribed in their respective capacities, and, all
of said persons being by me first duly sworn, said ROBERT E. ARTZ,
Testator, declared to me and to the said Witnesses in my presence
that said instrument is his Last Will and Testament, and that he
willingly made and executed it as his free and voluntary act and
deed for the purposes therein expressed; and that said Witnesses,
each on his oath stated to me, in the presence and hearing of said
Testator, that the said Testator had declared to them that said
instrument. is his Last Will and Testament, and that he executed the
same as such, and wanted each of them to sign it as a Witness; and
upon their oaths each Witness stated further that they did sign the
same as Witnesses in the presence of said Testator, and at his
request and that said Testator was at that time over the age of 18
years and was of sound mind,
~ ~n~ ~ L(S~ (SEAL)
o hart R _ A _7.
(SEAL)
(SEAL)
I
Sworn to and subscribed before me by ROBERT EtheRabove-named
JEFFP.EY B. ENGLE and ANGELA A. KOHLER
Testator and Witnesses, this ;ly day of f)4k y' A. D. 2002.
(!~r Notary Public
~---
NotarialSeal
Constance E. Stoneroad, Notary Public
Millersburg Boro, Dauphin County
My Commission Expires Mzy 7 0, 2001
~ Charney
iy~ ~~., Investment
~~ Group
o{ Wachovia Securities
January 3, 2008
chaffer R, Fngla I a,,n,~ Offjr;eg
ATTN: Constance E Stoneroad
2941 North Front Street
Suite 112
Harrisburg, PA 17110
Dear Connie:
700 South 28th Street
Harrisburg, PA 17103
(717) 232-6974
1-888-529-2973
(717) 232-6979 fax
I am writing you this letter in reference to the Estate of Robert E Artz and his date of death
values.
Below you will find the breakdown of all of Mr. Artz's holdings as of 9/29/2007.
Pacific Life Annuity
Initial Purchase Date - 10/28/1999
Initial Purchase Amount - $25,000
Date of Death Value - $18,676.60
ING Golden Select Annuity
Initial Purchase Date - 05/28/2003
Initial Purchase Amount - $7,630.42
Date of Deati~ 'Value - $5,959.50
Franklin High Income Fund C (FCHIX) 5839.264 shrs C~ 2.76 per share = $16,116.37
Franklin Income Fund CI C (FCISX) 17963.616 shrs C~ 2.09 per share = $37,~i43.96
Thank you for your time in this matter. Should you need any more information please feel
welcome to contact me at (717) 232-6974.
Sincerely,
~..
~~ ~~
Amanda J Barnett
Operations Manager
Client Service Specialist
VJachovia Securities, LLC, member NYSE and SIPC.
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CammunityBanks
Decedent's Name
Social Security Number
Date of Death
Robert E. Artz
198-18-7594
September 29, 2007
Accou T f'~ '" ~' J -
nt 1\umber _-_ V~ _ 13~1~5616
Account Type
Date Opened
Principal Balance
Accrued Interest at Date of Death
Balance at Date of Death
Maturity Date
Account Ownership
Names of Joint O~~ners, if any
Date Joint
OwnershipBeneficiary ~~~as
Established
Interest Rate
Additional Information
~~
335188467
Checking Tilne De
sit
08/03/06 ~
08/03/06
~__ $7,197.02 $10,000.00
-- $5.89 $40.05
__$7.202.91 - ~~ $10,040.05
------------- 0~','03i08
---_---.__ __--Individual ___ individual
0.9950% 5.2200%
(~, C-
E.. ~ ~ ~
Authorized Signature - Date
P.O. Box 350 Millersburg, PA 17061 Phone 1-866-255-2580
CommunityBanks
Decedent's Name
Social Security Number
Date of Death
Robert E. Artz
198-18-7594
September 29, 2007
~ ~ ~l
~
Account Number 335188468
__-- ^^ -
~ ~ a 188469
Account Type _ Time Deposit Time Deposit
Date Opened 08/03/06 08/03/06
Principal Balance $10,000.00 $10,000.00
Accrued Interest at Date of Death _ _ $40.05 $40.0
Balance at Date of Death $10,040.05 _ $10.040.0
Maturity Date 02/03/08 02/03/08
Account Ownership Individual Individual
Names of Joint Owners, if any
Date Joint -
OwnershipBenefciary was
Established
Interest Rate x.2200% J.220~)%
Additional Information
~.
~'
r
~ ~ ~ ~. ~~~
,,
Authorized Signature Date
P, O. Box 350 Millersburg, PA 17061 Phone 1-866-255-2580
CommunityBanks
Decedent's Name
Social Security Number
Date of Death
Robert E. Artz
198-18-7594
September 29, 2007
~~
Account l~rumber 33518&470
Account T3~pe
Date Opened
Principal Balance
Accrued Interest at Date of Death
Balance at Date of Death
Maturity Date
Account O~~nership
Names of Joint Owners, if any
Date Joint
Ownership/Beneficiary was
Established
Interest Rate
Additional Information
y~G~
'35188^~1
Time Deposit 'Time Deposit
08/03/06 08/10/06
$5,000.00 $10.581.37
$20.03 $31.78
_ ___ $ 5, 020.03 $10,613.15
02/03/08 02/10/08
Individual _ Individual
5.2200% 5.2200%
~~~
to
i
Authorized Signature
~~~~;
Date
P.O. Box 350 Millersburg, PA 17061 Phone 1-866-255-2580
Q M&TBank
499 Mitchell Road, Millsboro, DE 19966 Mai] Code DE-MB-12
Shaffer & Engle
Attorneys At Law
129 Market Street
Millersburg, Pennsylvania 17061
Re: Estate of Robert E At•tz
Social Security: 198-18-7594
Date ofDeath: September 29 2007
Phone (888) 502-4349
Fax (302) 934-2955
November 8, .2007
1 `~
~' '1
-~
~~\
Dear Sir or Madam:
Per your inquiry dated November 06, 2007, please be advised that at the time of death, the above-named decedent had on
deposit ~~-1th this bank the following:
1. Tipeof,4ccount Checking Account
Account Number 11358440
O>lmership (Names o~ Kim WArtz
RobertEAr~
Opening Date 12/28/81
Balance on Date ofDeatli $7,248.51
Accrued Interest ~' 0.17
Total - ----------------------- -
$7,248.68 ----
Please be advised, there was no safe deposit box found for the above decedent.
* if upon re~~iewing the information above, you believe there are additional accounts not referenced, please provide
us with an account number and/or the name of any possible joint account holder. For any additional information on
the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the
Hampden Office # 717-255-2293.
Sincerely,
~G~J~~ ~%
~ ~,
Nancy Clagett
Records Management