HomeMy WebLinkAbout03-1038Register of Wills of Cumberland
PETITION FOR GRANT OF
Estate of Robert G. Hartman Jr.
also known as
, Deceased
Janet W. Hartman and Daniel J. Hartman
County, Pennsylvania
LETTERS
~
Social Security No. 177- 24- 7063
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut na~3~l~ in the last Will of
the Decedent. dated 08/01/19~61 codicil(s) dated None
none
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
none
B. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumb er 1 and
County, Pennsylvania with his/her last family
orprincipalresidenceat 605 Allen Street, Borough of New Cumberland, New Cumberland, PA 17070
Decedent, then 72years of age. died ll/09/200~at
(list street, number, and municipality)
605 Allen St., New Cumberland, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
(Location)
150,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
I Si~;nature Typed or printed name and residence
/~7 ___~i ------- | Janet W. Hartman
~~65 Allen Street, New Cumberland, PA 17070
~ ~ ~ // /'~ ~ I~D-aniel J. I4artman
South 15th St., Camp H,Z1, PA 17011
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSysterns, Inc. Fon'n R W- 1 (1991 )
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ¥'~4~day of
Estate of Robert
Social Security No:
AND NOW,
G. Hartman Jr.
177 - 24 - 70~te of Death:
11/09/2003
Deceased
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters [-~---'~tamentary ~--~ministration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are herebygrantedto Janet W. Hartman and Daniel J. Hartman
in the above estate and that the instrument(s) dated 08/01/1996
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s)(,,~... $
Renunciation ........ $
Affidavits ( ) .... $
Extra Pages ( IO ) .... $
Codicil ........... $
JCP Fee .......... $
Inventory .......... $
Other ........... $
TOTAL ......... $
Prepared by the Pennsylvania Bar Association
5.00
Attorney:
I.D. No:
Address:
Telephone:
Copyright (c) 1996 form software only CPSystems, Inc.
L ' - I~egis~(~Wills0 I d
John E. Slike
06262
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17011
717/737-3405
Form RW-1 (1991)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fiiing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
9650316
No.
Local Registrar
NOV 1 1 2003
Date
T 43 Rev. 2/87
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
72 w,.
Ct~berland
,,.. ~er ,~gi~er~g & S
, ~i~~ J~et Weitzel
~w ~land, PA 17070
~,. NO~E ~. Ha~uii~ Sr. J,e ~ris ~r
~ms~s,,~, ~' ~ "' ~n o~ [,, 605 All~ St., ~w O~~, PA 17070
STATE FI;rE NUMBER
Robert G. Hartman Jr. ,. Male ,. 177 -- 24 -- 7063 4Abvember 9, 2003
j 4-1-31 Pt. AlleghenyP,A ,-, [] E~o~.~ [] mE] OmER:~ [] ~ ~ o~ []
o. 7.
CIT~. BORO, TWP OF DEATH IFAClLn~ NAME fit n~ in~bo~, g~ve s~me~ ar~ numbe~) WA~ DECEDENT OF HISPANIC ORIGIN? '
N~*,' Cca~berland ~.~ ~, [] ,~,.~.wc~,~ I(S~'~')
,.. .. 605 Allen Street I** .,,.,,o,~....,~. J~o. Wh±te
I ~,ARn~ ST~U8 - Mam~
~ AN AUTOPSYJWERE AUTOPSY FINO(NGS
DUE 'E) (OR AS A CCNSEOUENCE OFt:
DUE TO (OR AS A CONSEQUENCE OF}:
'MEDICAL EXAMINER/CORONER
................................... : ......... ' · , . ........ ()
d
DATE OF INJURY JTIME OF INJURY
(M~h. Day, Year)
PLACE OF INJURY - Al home. tarm, SI;eel. facto~f, oltice
OF
ROBERT G. HARTMAN, JR.
I, ROBERT G. HARTMAN, JR., of Camp Hill, Cumberland County,
and Commonwealth of Pennsylvania, do make, publish and declare this to be my
Last Will and Testament, hereby revoking all Wills and Codicils by me at any
time made.
ITEM I: I direct the Executor to pay the expenses
of my last illness and funeral expenses from subsection (b) of ITEM IV of the
residue of my estate as an expense and cost of administration of my estate.
ITEM II: If I die before my wife, JANET W.
HARTMAN, I give to her all of my household furniture and furnishings, books,
pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of
household or personal use or adornment and all policies of insurance thereon. If I
do not die before my wife, ! make this gift to my children living at the time of my
death, to be divided among them as they shall agree.
ITEM III: I specifically decline to exercise the
Special Power of Appointment contained in the Last Will and Testament of my
wife, JANET W. HARTMAN.
ITEM IV:
I give the residue of my estate, not
disposed of in the preceding portions of this Will, as follows:
Page 1
(a) To my Trustees hereinafter named, IN TRUST, to be
administered and distributed as provided in ITEM V, the largest
amount that can pass free of Federal estate tax under my Will by
reason of the unified credit and the state death tax credit allowable to
my estate but no other credit and after taking account of dispositions
under other items of this Will and property passing outside of this
Will which do not qualify for the marital or charitable deduction and
after taking account of charges to principal that are not allowed as
deductions in computing my Federal estate tax.
(b) The balance of my residuary estate shall be paid to my
wife, JANET W. HARTMAN, ff she survives me. If she does not
survive me, this portion of my estate shall be added to the Trust
funded pursuant to subsection (a) and shall be administered and
distributed as provided in ITEM V.
ITEM V:
the Trust established by ITEM IV (a):
The following provisions shall apply to
(a) This Trust shall be known as The Hartman Family
Credit Trust.
(b) The Trustee(s) shall pay to or for the benefit of my wife,
JANET W. HARTMAN, all of the net income of this Trust in
convenient installments, but not less frequently than annually. The
Trustee(s) shall also pay to my wife, so much of the principal of this
Trust as may be necessary in the sole discretion of the Trustee(s) for
the proper support, maintenance and medical care of my wife.
Page 2 .~~//
(c) Upon the death of my wife, the Trustee(s) shall pay over
all of the remaining assets, to one or all, or less than all of my issue,
in the amounts, and in the estates, in trust or otherwise, as my wife
may direct, making specific reference to this Special Power of
Appointment, either by written instrument filed with the Trustee(s)
during her lifetime or by her Will. In no event may this Special
Power of Appointment be exercised in favor of my wife, her estate or
creditors of either.
(d) If this Special Power of Appointment is not exercised by
my wife, in whole or in part during her lifetime, or in her Will, then
upon the death of my wife, the Trustee(s) shall divide the
unappointed principal into as many equal parts as there are then
living children of mine and then deceased children of mine
represented by then living issue. The Trustee(s) shall distribute one
share to each living child, and shall hold one share as a separate
Trust for the benefit of the issue of each deceased child, per stirpes.
(e) In each Trust established for the benefit of the issue of a
deceased child of mine, the Trustee(s) shall quarterly pay the net
income to or for the benefit of the issue of my deceased child, per
stirpes, living at each time of quarterly distribution. As soon as any
issue of my deceased child attains the age of twenty-one (21) years,
and in no event later than twenty (20) years following the death of
the survivor of my wife or myself, the Trustee(s) shall distribute the
remaining principal to the then living issue of my deceased child, per
stirpes.
Page 3
ITEM VI: My wife, JANET W. HARTMAN, shall
have the noncumulative right to withdraw FIVE THOUSAND ($5,000) DOLLARS
from the principal of the Trust established under ITEM V of this Will each
calendar year during which she is entitled to receive income. If my wife is living
on the last day of each year, she shall also have the right to withdraw an amount
equal to five (5%) percent of the net market value of the principal on the last day
of the year less the amount, if any, previously withdrawn during the year. The
Trustee(s) shall make this payment within thirty (30) days of the close of the year.
This right of withdrawal is noncumulative and may be exercised only in writing
delivered to the Trustee(s) within thirty (30) days prior to the last day of each
calendar year.
ITEM VII: I direct that all inheritance and estate
taxes becoming due by reason of my death, whether payable by my estate or by
any recipient of any property, shall be paid by the Executor from the principal of
the trust established under ITEM IV (a) and administered under ITEM V. The
Executor shall have no duty or obligation to obtain reimbursement for any such
tax so paid, even though on proceeds of insurance or other property not passing
under this Will.
ITEM VIII: No part of the income or principal of any
Trust created by this Will shall be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary
prior to his or her actual receipt of income or principal distributed. The
Trustee(s) shall pay the net income and the principal to the beneficiaries specified
by me, as their interests may appear, without regard to any attempted
anticipation, pledging or assignment, and without regard to any claim or
attempted levy, attachment, seizure or other process against the beneficiary.
Page 4
ITEM IX: The Executor and the Trustee(s) shall
each possess the following powers, each of which may be exercised in a fiduciary
capacity only:
(a) To retain any investments I have at my death, including
specifically those consisting of stock of any bank even if I have named
that bank as the Executor or Trustee.
(b) To vary investments, and to invest in bonds, stocks,
notes, real estate mortgages or other securities or in other property,
real or personal, without being restricted to so-called 'qegal
investments", and without being limited by any statute or rule of law
regarding investments by fiduciaries.
(c) In order to divide the principal of a Trust or for any
other purpose, including final distributions, the Executor and
Trustee(s) are authorized to divide and distribute personal property
and real property, partly or wholly in kind, and to allocate specific
assets among beneficiaries and Trusts so long as the total market
value of each share is not affected by the division, distribution or
allocation in kind. The Executor and Trustee(s) are each authorized
to make, join in and consummate partitions of lands, voluntarily or
involuntarily, including giving of mutual deeds, or other obligations,
with as wide powers as an individual owner in fee simple.
(d)
property severally or in conjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the
Page 5
To sell either at public or private sale real and personal
purchaser(s), conveying a fee simple title. No purchaser shall be
obligated to see to the application of the purchase money or to make
inquiry into the validity of any sale(s). The Executor and Trustee(s)
are authorized to execute, acknowledge and deliver deeds,
assignments, options or other writings as necessary or convenient to
any of the power conferred upon the Executor and Trustee(s).
(e)
estate.
To mortgage real estate, and to make leases of real
(f) To borrow money from any person, including the
Executor or Trustee(s), to pay indebtedness of mine or of my estate,
expenses of administration or inheritance, legacy, estate and other
taxes, and to assign and pledge assets of my estate or any Trust
established by this Will.
(g) To pay all costs, taxes, expenses and charges in
connection with the administration of my estate or any Trust
established under this Will. If any death taxes are payable with
respect to my estate, these taxes shall be paid from the Trust
established by Item IV (a).
(h) To make distributions of income and of principal to the
proper beneficiaries, during the administration of my estate, with or
without court order, in such manner and in such amounts as the
Executor deems prudent and appropriate.
Page 6
(i) To vote shares of stock which form a part of my estate or
any Trust established under this Will, and to exercise all the powers
incident to the ownership of stock.
(j) To unite with other owners of property similar to
property in my estate to carry out plans for the reorganization of any
company whose securities form a part of my estate.
(k) To disclaim any interest in property which would devolve
to me or my estate by whatever means, including but not limited to
the following means: as beneficiary under a will, as an appointee
under the exercise of a power of appointment, as a person entitled to
take by intestacy, as a donee of an inter vivos transfer, and as a
donee under a third-party beneficiary contract.
(1) To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized
by law.
(m) To employ custodians of property, investment or business
advisors, accountants and attorneys as the Executor or Trustee(s)
deems appropriate, and to compensate these persons from assets of
my estate or trust, without affecting the compensation to which the
Executor and Trustee(s) are entitled.
(n) To do all other acts in their judgment necessary or
desirable for the proper and advantageous management, investment
and distribution of the estate and Trusts established under this Will.
Page7 ~~/
ITEM X: Any person, other than my wife, who has
died within thirty (30) days of my death, or under such circumstances that the
order of our deaths cannot be established by proof, shall be deemed to have
predeceased me. If my wife and I die simultaneous]y, or under such
circumstances that the order of our deaths cannot be established by proof, my wife
shall be deemed to have survived me. Any person (other than myself) who has
died at the same time as any then beneficiary under this Will, or under such
circumstances that the order of deaths cannot be established by proof, shall be
deemed to have predeceased that beneficiary.
ITEM XI: If a beneficiary under the age of
twenty-one (21) years is entitled to receive assets under this Will, that person
named by my Trustee(s) shall receive those assets as Custodian for the beneficiary
under the Pennsylvania Uniform Transfers to Minors Act. The Custodian may
receive and administer all assets authorized by law, and shall have full authority
as provided in the Pennsylvania Uniform Transfers to Minors Act to use assets in
the manner the Custodian deems advisable for the best interests of the
beneficiary. I also designate that person named by my Trustee(s) as successor
Custodian of any property for which I am custodian under any Uniform Gifts to
Minors Act or Uniform Transfers to Minors Act.
ITEM XII: I appoint my wife, JANET W.
HARTMAN, and my son, DANIEL J. HARTMAN, as Co-Executors and Co-
Trustees, referred to in this Will as "Executor" and "Trustee". In the event my
wife, JANET W. HARTMAN, cannot act or continue to act as Executor and/or
Trustee for any reason, my son, DANIEL J. HARTMAN, may act alone in that
Page 8
capacity. The Executor, Trustee and Custodian are specifically relieved from the
obligation of filing bond or entering security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding eight (8) pages, at
the end of each page of which I have also set my initials for greater security and
better identification this ] day of ~~~jR.'
(SEAL)
We, the undersigned, hereby certify that the foregoing Will was
signed, sealed, published and declared by the above-named Testator as and for his
Last Will and Testament, in the presence of ns, who, at his request and in his
presence and in the presence of each other, have hereunto set our hands and seals
the day and year first above written, and we certify that at the time of the
execution thereof, the said Testator was of sound and disposing mind and memory.
Residing at
Residing
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
) SS:
COUNTY OF )
I, ROBERT G. HARTMAN, JR., Testator, whose name is signed to
the attached or foregoing instrument, having been duly qualified according to law,
do hereby acknowledge that I signed and executed the instrument as my Last Will
and Testament; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
Sworn to and subscribed before
me this / day of
Lf~~- , 19~g.
--~) Notary~ublic
My Commission Expires:
(SEAL)
I Notarial Seal
,U,n,~d~.~. OIse__n, Notary Public
r~am~ourg, uauphin County
~ss'on Expires Sept. 8, 1996
Member, Pennsy~vaniaAssoda~on of Notades
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
) SS:
COUNTY OF )
,'~ i'r~i,z 3'~ t,'q4.~ /~o,~ and
the Witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present and
saw Testator, ROBERT G. HARTMAN, JR., sign and execute the instrument as
his Last Will and Testament; that Testator signed willingly and that he executed
said Will as his free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testator signed the Will as Witnesses;
and that to the best of our knowledge the Testator was at that time eighteen (18)
or more years of age, of sound mind and under no constraint or undue influence.
' 7 Witness -- ~ Witness
Sworn to and subscribed before
me this / day of
5~~ , 1976.
t Public
My Commission Expires:
(SEAL)
Notarial Seal
Unda J. Olsen, Notary Public
Harrisburg, Dauphin County
My Commission E~'.pires Sept. 8, lg96
Member, Pennsyivania~ation of Nk)tades
63282 1
OF
ROBERT G. tL~RTI~L~, JR
METTE, EVANS & WOODSIDE
ATTORNEYS AT LAW
HArrISBURG. PENNSYLVANIA 17110-0950
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Robert G. Hartman, Jr.
Date of Death: November 9, 2003
Will No. 21-03-1038 Admin. No.
To the Register:
I certify that notice of Estate Administration required by Rule 5.6(a) of the
Orphans' Court Rules was served on or mailed to the following beneficiary of the above-
captioned estate on January 5, 2004.
Name
Janet W. Hartman
Daniel J. Hartman
Kim H. Kelly
Address
605 Allen Street, New Cumberland, PA 17070
127 S. 15th Street, Camp Hill, PA 17011
914 Maplewood Lane, Enola, PA 17025
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
,.J0h~ E. Slik-e, Esquii:e/
, 2109 Market Street /
u' Camp Hill, PA 17011
(717) 737-3405
Capacity:
X
__ Personal Representative
Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RE~CEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD O03546
SLIKE JOHN E
2109 MARKET STREET
CAMP HILL, PA 17011
fold
ESTATE INFORMATION: SSN: 177-24-7063
=ILE NUMBER: 2103- 1038
DECEDENT NAME: HARTMAN ROBERT G JR
DATE OF PAYMENT: 02/10/2004
POSTMARK DATE: 02/06/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,000.00
REMARKS:
TOTAL AMOUNT PAID:
RECEIVED JANET W HARTMAN
IN C/O JOHN E SLIKE
$2,000.00
SEAL
CHECK# 8350
INITIALS: JA
RECEIVED BY'
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
C'"OMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF iNDiVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003690
SLIKE JOHN E
2109 MARKET STREET
CAMP HILL, PA 17011
..... ;-- fold
ESTATE INFORMATION: SSN: 177-24-7063
FILE NUMBER: 2103- 1038
DECEDENT NAME: HARTMAN ROBERT G JR
DATE OF PAYMENT: 03/17/2004
POSTMARK DATE: 03/09/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
04106285 $57.91
REMARKS:
TOTAL AMOUNT PAID:
$57.91
CHECK//1006
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
qEPARTRENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 180601
HARRISBURG, PA 17118-06D1
REV-ISq3 EX AFP C09-00)
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FILE NO. 21 03-1038
ACN 0q106285
DATE OZ-2q-ZOOR
DAN[EL d HARTNAN
127 S 15TH
CAMP HiLL
'04 HAP, 17
.¢ TYPE OF ACCOUNT
EST. OF ROBERT G HARTNAN [] SAVINGS
S.S. NO. 177-2~-7065 [] CHECKTNG
DATE OF DEATH 11-16- Z 003 [] TRUST
:01 COUNTY CUMBERLAND [] CERT'rF.
REHZT PAYHENT AND FERNS TO:
REGTSTER OF NILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
PENNSYLVAN/A STATE BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Lams of the Commonwealth
of Penn=y!v~nia. gue~t~ons may be answered by c~tling f?171 787-8~27.
COMPLETE PART ! BELON ~ ~ # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Accoun'~ No. 1001068~ De~e 05-10-199R
Established
Account Balance 7,721.20
Percan~ Taxable X 16. 667
Aeoun* Sub~ac~ ~o Tax 1,286.89
Tax Ra~a X .0q5
Po~en~ial Tax Due 57.91
To insure proper credit to your account, two
(Z) copies of this notice must accompany your
payment to the Register of Rills. Hake check
payable to: "Register of Rills, Agent".
NOTE: If tax payments ara made aithin three
(3) months of the dacedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
TAX
L/NE
PART TAXPAYER RESPONSE
ITl ........................
A, ~Tha above information and tax due is correct.
~--~1. You may choose to remit payment to the Register of Rills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE ~ Nills and an official assessment ell1 be lssuad by tho PA Department of Revenue.
BLOCK J B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~and/or PART F~-~below.
If you indicate a different ~ax rate, please s~a~a your
relationship ~o decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1. Da~e Established I
2. Accoun~ Balance 2
3. Percent Taxable $ ~
q. Aeoun~ Subjec~ ~o Tax q
S. Debts and Deductions $ -
6. Aeoun~ Taxable 6
7. Tax Ra~e 7 ~
8. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
iOiAL (Enter on Line $ of Tax Computation)
c~ Under penal~iqr~-1[41-~k~.y, T declare ~ha~ ~he fac~s ! have reported above are ~rue, correct and
TAXPAYEW
TELEPHONE NUMBER DATE
E-143 EX
Attention: TIC 340
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 28O6O1
HARRISBURG PA 17128-0601
MAILED FR
j,,, i lil,411~,i,ll,'l,ll,,l'll"till"li~l~
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVXSTON
DEPT. 280601
HARRISBURG, PA 171Z8-060!
DANIEL J HARTMAN
127 S 15TH
CAMP HILL
COHMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOT/CE OF XNHERXTANCE TAX
APPRATSEHENT. ALLONANCE OR DTSALLONANCE
OF DEDUCTXONS., AND ASSESSHENT OF TAX ON
JOXNTL¥ HELD OR TRUST ASSETS
R*~; :?' '. DATE 04-12-2004
~::~ ~. ESTATE OF HARTMAN JR
DATE OF DEATH 11-09-2005
FTLE NUMBER 21 0:5-10:58
'04 A?R ~ 4 "~ .... t COUNTY CUHBERLAND
' SSN/DC 177-24-7065
ACN 04106285
Amoun'l: RemZ'l:'ted
ROBERT
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~
REV-1548 EX AFP [01-03)
NOTICE OF XNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS
DATE 04-12-2004
ESTATE OF HARTMAN dR ROBERT G DATE OF DEATH 11-09-2005 COUNTY CUHBERLAND
FILE NO. 21 03-1038 S.S/D.C. NO. 177-24-7065 ACN 04106285
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK ACCOUNT NO. 10010684
TYPE OF ACCOUNT: C ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 05-10-1994
Account Balance 7,7Z1.ZO
Percen~ Taxable X 0.166
Amoun~ Sub~ec~ ~o Tax 1,286.89
Debts and Deductions - .00
Taxable Amount 1,286.89
Tax Ra~e ~ .45
Tax Due 57.91
TAX CREDZTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYHENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE
RECEIPT
NUHBER
I DISCOUNT (+)
!INTEREST/PEN PAID (-)
AMOUNT PAID
PAYHENT HUST BE MADE BY 08-10-2004~. TOTAL TAX CREDIT
:BALANCE OF TAX DUE]
INTEREST AND PEN.
TOTAL DUE
ZF PATD AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDZTTONAL /NTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REI~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
.00
57.91
.00
57.91
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT=
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit Nith your payment to the Register of Nills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF HILLS, AGENT.
A refund of a tax credit) which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of
the Register of Nills) any of the Z3 Revenue District Offices or by calling the special Iq-hour answering service
for forms ordering: 1-BOg-36Z-g050~ services for taxpayers with special hearing and or speaking needs:
1-DO0-4qT-30Zg (TT only).
Any party in interest not satisfied with the appraisement, allowance) or disalloeance of deductions or assessment
of tax (including discount or interest) as shown on this Notice amy object eithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue) Board of Appeals) Dept. Z81OZ1, Harrisburg) PA 171ZD-lOZ1, OR
--electing to have the matter determined at the audit of 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. ZB0601, Harrisburg, PA 17IZB-0601
Phone (717) 787-6505. See page S 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 ts paid within three (3) calendar months after the decedant's death, a five percent (SI)
discount of the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996) the first day after the and of the 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 of death) to the date of payment. Taxes which became delinquent before January l, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164.
AIl taxes which became delinquent on or after January 1, 198Z 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 ~or 1982 through ZOOq ara:
Interest Daily Interest Oaily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198'~ ZOZ .o00sq8 1988-1991 llZ .000301 20~1 9X .000Z47
1983 16Z .O00q3B 199Z 9Z .O00Z~7 ZOOZ 6Z .O00Z19
1966 11Z .000301 1993-1996 7Z .O0019Z ZOO3 5X .000137
1985 13Z .000356 1995-199& 9Z .0002¢7 ZO0~ qZ .000110
1966 IOZ .00027q 1999 7Z .00019Z
1987 9Z .O00Zq7 ZOOO 8Z .OOOZ19
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST 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 the
Notice) additional interest must be calculated.
BUREAU OF TNDTVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRTSBURG; PA 17128-0601
COMMONNEALTH OF PENNSYLVANTA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
DANIEL d HARTNAN
127 S 15TH
CAMP HILL PA 17011
DATE Oq-12-200q
ESTATE OF HARTMAN dR
DATE OF DEATH 11-09-2005
~X~NUMBER ZX 05-1058
OOUNTY CUMBERLAHD
ACN 0q106285
Amount: Rem*i t:t:ed
REV-X,~O? EX AFP COl-n3)
ROBERT
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To Lnsure proper credLt: t:o your account:, submit: t:he upper por%ion of t:his for. wLt:h your t:ax payment:.
CUT ALONG THIS LINE ~ RETAIN LONER PORTXON FOR YOUR RECORDS
REV-1607 EX AFP (01-03) ~ XNHERZTANCE TAX STATEMENT OF ACCOUNT
ESTATE OF HARTMAN JR ROBERT G FILE NO. 21 05-1058 ACM 0q106285 DATE Ofi-12-200fi
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHO#N BELOW
ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND:. ZF APPLICABLE.,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: O~-lZ-ZOOq
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
57.91
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (- AMOUNT PAID
05-09-200q CD003690 .00 57.91
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
XF TOTAL DUE XS LESS THAN $1,
NO PAYMENT XS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CRED'rT
57.91
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORN FOR INSTRUCTIONS. )
PAYMENT:
Detach tho top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- Tf RESIDENT DECEDENT make check or money order payable to: REGTSTER OF NTLLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: CONMON#EALTH OF PENNSYLVANXA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return) may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at
the Office of the Register of Mills, any of tho Z3 Revenue District Offices or from the Department's Iq-hour
anseering service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing end / or
speaking needs: 1-800-qq7-30Z0 (TT
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue) Bureau
of Individual Taxes, ATTN: Pest Assessment Review Unit) Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (52) discount
of tho tax paid is allowed.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed en the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daiIy rate of .O0016q. AIl taxes ahlch became delinquent on and after
January 1, 198Z 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 1982 through ZO0~ are:
Interest Daily Interest Daily Interest Dally
Year Rate Factor Year Rate Factor Year Rate Factor
1982 202 .000568 1988-1991 112 .000301 2001 9Z .O00Zq7
1983 162 .000q38 1992 9Z .OOOZq7 2002 6Z .O0016fi
198q 112 .000301 1993-199q 7Z .000192 ZOOS 52 .000137
1985 132 .000356 1995-1998 92 .0002~7 ZO0~ qZ .000110
1986 102 .OOOZ7fi 1999 72 .000192
1987 9X .0002~7 ZOOO 82 .000219
--Interest ls calculated as follows:
XNTEREST= BALANCE OF TAX UNPATD X NUNBER OF DAYS DELI'NIIUENT X DAXLY TNTEREST 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 the
Notice, additional interest must be calculated.
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SAIDIS, SHUFF, FLOWER & LINDSAY
ATI'ORNEYS AT LAW
26 WEST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
GENERAL ACCOUNT
Harrisburg, PA
60-7238/2313
LZgI-OLOLI Vd 'PupaqumD SaN
'1~ U~lW g09
5036
09~08/2004
PAY TO THE Register of Wills - Cumberland 15.00
ORDER OF $
Fifteen and N~/~~~**************************************************************************************
DOLLARS
MEMO
Register of Wills - Cumberland
One Courthouse Square
Carlisle, PA 17013
," 0 5 0 t P, 5,"
~." 2 t I, :1, ? 2 ~fi ?~: ~ 70800 ~ 1,0
JOHN E. SLIKE
ROBERT C. SAIDIS
GEOFFREY S. SHUFF
JAMES D. FLOWER, JR
CAROL J. LINDSAY
MATTHEW J. ESHELMANt
THOMAS E. FLOWER
LINDSAY GINGRICH MACLAY
JACLYN SMITH
LAW OFFICES
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
CAMP HILL, PENN SYLVANIA 17011
TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EMAIL: attorney@ssfl-law.com
ARL ·
26 WEST HIGH STREET
CARLISLE, PA 17013
TELEPHONE: (717)243-6222
FACSIMILI~ (717)243-6486
~'Board Certified Creditors'
Rights Representation
REPLY TO CAMP HILL
September 8, 2004
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Re.'
Dear Ladies:
The Estate of Robert G. Hartman
File No. 21-03-1038
Thank you.
Very truly yours,
/sly
Enclosures
SAIplS, SHUFF, FLOWER & LINDSAY
./~(etB~ ~. Y!~fgling, Estate maralegal
It is my understanding that an Inheritance Tax Return was sero to your office for filing in
regard to the above estate. I was not aware that our clients had done this, and this is the reason
there was no filing fee sent. Therefore, enclosed is a check for $15.00 for the filing of the return.
Kindly send a receipt to our office in the envelope provided.
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOF REVENUE
DEPT. 280601
HARRISBURG, PA17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hartman Jr. Robert G.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
o 3 I 04/01/1931
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hartman, Janet W.
~ 1. Original Retum
4. Limited Estate ·
6. Decedent Died Testate
(Attach copy of Will)
[~ 9. Litigation Proceeds Received~] 10.
OFFICIAL USE ONLY
FILE NUMEER
21-03-1038
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
177 - 24- 7063
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~L~°uf ~/t1~r~r~.~tSupplemental Return ~
umor~,=.~o.=~=7 Compromise (date of death after 12-12-
Be~ Mainlined a Uving Trust
~py of Trust)
Spousal Pove~y Credit
~f death be~n 12-31-91 and 1-1-95)
165-26-6159
(df~
3. Remainder Retum pn
5. Federal Estate Tax Return
il. Total Number of Safe Depo
11. Election to tax under Sec. 9
(Attach Sch O)
NAME
John E. Slike
FIRM NAME (If Applicable)
Saidis, Shuff, Flower & Lindsay
TELEPHONE NUMBER
717/737-3405
1Real Estate (Schedule A) (1)
2Stocks and Bonds (Schedule B) (2)
3Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4Mortgages & Notes Receivable (Schedule D) (4)
5Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6Jointty Owned Property (Schedule F) (6)
[~Separate Billing Requested
COMPLETE MAILING ADDRESS
2109 Market St.
Camp Hill, PA-~r011
None
None
None
None
87,12,6,: 92
2,332.22
OFFICtAL USE ONLY
I
(7)
7inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8.Total Gross Assets (total Lines 1-7)
9Funeral Expenses & Administrative Costs (Schedule H) (9)
l(~Debts Df Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11Total Deductions (total Lines 9 & 10)
l~let Value of Estate (Line 8 minus Line 11)
13Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14tlet Value Subject to Tax (Line 12 minus Line 13)
126,666.54
14,479.33
None
(ii) 216,125.68
(11) 14,479.33
(12) 201,646.35
(13)
(14) 201,646.35
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
150,mount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16~,mount of Line 14 taxable at lineal rate
17Amount of Line 14 taxable at sibling rate
180,rnount of Line 14 taxable at collateral rate
191'ax Due
20.
152,892.70 x .o 0 (15) 0.00
48,753.65 X .0 45 (16) 2,193.91
0.00 X .12 (17) 0.00
O. O0 X .15 (18). O. O0
(19) 2,193.91
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
605 Allen Street
CITY STATE ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1.Tax Due (Page 1 Line 19)
2Credits/Payments
A. Spousal Poverty Credit
Bo Prior Payments
C. Discount
2,057.91
105.26
(~)
Total Credits ( A + B + C ) (2)
2,193.91
3Jnterest/Penalty if applicable D. Interest
E. Penalty
Total InterestJPenalty ( D + E ) (3)
4if 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)
5If 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)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1Did 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; ...........
¢. retain a reversionary interest; or ....................................
d. receive the promise for life of either payments, benefits or care? ...................
2If death occurred alter December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ [~ []
3Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? .............................................. r~ ~-~
4Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? ................................ r-~ r'~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
2,163.17
0.00
0.00
30.74
0.00
30.74
Under penalties of perju~, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tree,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUREOF~SONRESP.ONSIBLEF. O.~FII~N~RE~ Janet W. Hartman and Daniel J Hartman
~~/~',~5 Allen Street '
...................
SIGNATURE ~
For dates~
surviving ~
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 of a 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.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
i EPARE~OTH~HA~R~PRESENTATIVE Saidis, Shuff, Flower & Lindsay
/~ ~ ~ - 2109 Market St. / / .
..........................
f~lueath on or affer 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 se is 3% [72 P.S. 9116 (a) (1.1) (i)].
REV-1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert G. Hartman Jr. SS# 177-24-7063 11/09/2003 21-03-1038
Include the Droceeds of litigation and the date theproceeds were received by the estate. All I~rol~erty jointly-owned with the right of
survivorsh,p must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 82,626.92
Copyright (c) 1996 form software only CPSystems, Inc.
Hartman & Assoc. stock purchase agreement,
payable to trust for decedent's widow.
Value represents remaining payments at date of death.
Undivided interest in hunting camp
per buy-sell agreement. Decedent's interest passes to son,
Hartman by agreement of members.
Dan
4,500.00
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Form REV-1508 EX (Rev. ~-97)
$ 87,126.92
REV-1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert G. Hartman Jr.
SCHEDULE F
JOINTLY-OWNED PROPERTY
SS~ 177-24-7063 11/09/2003
FILENUMBER
21-03-1038
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.Janet Hartman spouse
B. Daniel Hartman
605 Allen St.
New Cumberland, PA
127 S. 15th St.
Camp Hill, PA 17011
s on
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
Include name of financial institution and bani DATE OF DEATH DECD'S VALUE OF
ITEM FOR JOIN'[ MADE account number or similar identifying numbe
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERE~
1 A,B 05/10/94 PA State Bank, checking
acct. #10010684 13,990.52 16.67~ 2,332.22
TOTAL (Also enter on line 6, Recapitulation) $ 2,3 3 2.2 2
(if more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSysterns, Inc.
For~ REV-1509 EX (Rev. 1-97)
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert G. Hartman Jr.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
SS# 177-24-7063 11/09/2003
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
FILE NUMBER
21-03-1038
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.
NUMBER A'I-rACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~F APPLICABLE)
1 Balance of payments due under
retirement agreement payable
to decedent's widow per agr.
with I~artman & Assoc. /oo~;~,
Balance due at date of death 126,666.54 ~~ 126,666.54
TOTAL (Also enter on line 7, Recapit~ation) 126,666.54
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97)
REV-1511 EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert G. Hartman Jr. SS~/ 177-24-7063 11/09/2003 21-03-1038
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
Bo
5.
6.
7.
:UNERALEXPENSES:
Myers-Hamer Funeral Home
Rolling Green Cemetery
White Pines, Funeral luncheon
~DMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
C~ty
Year(s) Commission Paid:
State Zip
Attomey'sFees Saidis, Shuff, Flower & Lindsay
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Janet W. [qartman
Street Address 605 Allen Street
City New Cumberland State PA Zip 17070
Relationship of Claimant to Decedent s p ous e
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
2,850.00
610.00
3,994.88
OtherAdministrativeCosts
Cumberland Law Journal, estate notice
Patriot News, estate notice
filing fee for tax return
3,000.00
3,500.00
290.00
75.00
144.45
15.00
TOTAL (Also enter on line 9, Recapitulation) $ 14,4 7 9.3 3
Form REV-1511 EX (Rev. 1-97)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert G. Hartman Jr.
NUMBER
2
II,
SCHEDULE J
BENEFICIARIES
SS~ 177-24,-7063 11/09/2003
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
FAXABLE DISTRIBUTIONS [include out~g~ s~usal dist~butions, ~d
tmnsfem under S~. 9116(a)(1.2)]
Klm H. Kelly
914 Maplewood Lane
Enola, PA
Daniel J. Hartman
127 S. 15th Street
New Cumberland, PA
17070
Janet W. Hartman
605 Allen Street
New Cumberland, PA 17070
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-03-1038
daughter
s on
spouse
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
AMOUNTORSHARE
OF ESTATE
remainder bene.
of by-pass tr.
remainder bene.
of by-pass tr.
hunting camp
life estate
value of trust
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN, 15 THRU 181 AS APPROPRIATEI ON REV 1500 COVER SHEET
~ION-TAXABLE DISTRIBUTIONS:
!~. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
3, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
$ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 fon~ software only The Lackner Group, Inc, Form REV- 1513 EX (Rev. 9-00)
REV-1514 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
ICheck Box 4 on Rev-1500 Cover SheetI
Copy f;l
ESTATE OF FILE NUMBER
Robert G. Hartman Jr. SS~ 177-24-7063 11/09/2003 21-03-1038
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found
in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1~89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
~ Will [--'] Inter~ivos Deed of Trust ~ Other
NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
Janet W. Hartman 03/04/31 73 Life ,~7'~ Term~"~rs
Daniel J. Hartman 04/05/58 46 Life ,~:'~ Term(:~ars
Klm H. Kelly 05/07/55 49 Life ,F-X-J Term~/ars
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate- ~-~2% (~
3. Value of life estate (Line 1 multiplied by Line 2)
1(~ Var~"~ Rate % 0.0
$ 68,147.59
0.36773
$ 25r060.05
NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITY IS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
Life~)F~ Term o~'~rs
Life ,)F--1 Term c~-~rs
Life , )Fl Term c~-~rs
Life ,)F'-I Term c~-~ars
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - r'~ekly (52) E~kly (26) (~ (12)
~uarterly (4) [-~mi-annually (2) ,al~ally (1) ( )
3. Amount of payout per padod
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate- ~--~-'{/2°/o ~ 1[~-'~ V4~le Rate o~). 0
6. Adjustment Factor (see instructions)
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x Line 6
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
0.00
0.00
0.00
0.0000
0.0000
0.00
0.00
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of
this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16, 17 and 18.
(If more space is needed, insert additional sheets of the same size)
Copyright (c)2000 form software only The Lackner Group, Inc. Form REV-1514 EX (Rev. 9-00)
REV-1647 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert G. Hartman 21-03-1038
SCHEDULE M
FUTURE INTEREST COMPROMISE
(Check Box 4a on Rev-1500 Cover Sheet)
Jr. SS~/ 177-24-7063 11/09/2003
This schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession
and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
II.
Will [~ Trust J~ Other
;eneficiaries
NAME OF
BENEFICIARY
1. Janet W. }{artman
Z. Daniel J. Hartman
3. Klm H. Kelly
4.
;or decedents dying on or after July 1, 1994,
AGE TO
RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY
spouse 73
son
daushter
03/04/1931
04/05/1958
05/07/1955
46
49
a surviving spouse exemised or intends to exercise a right of withdrawal within 9 months
~ the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exemises such
/ithdrawal right.
[--'] Unlimited ri~lht of withdrawal ~ Limited ri~lht of withdrawal
III. ;xplanation of Compromise Offer:
Executrix proposes taxes to the remainder interest in the residuary component of
the Hartman Family Credit Trust at 4.5Z based upon the probability of decedents
issue surviving decedent's spouse. Decedent's spouse does not anticipate the
need to invade the principal of the Trust during her lifetime.
IV. ',ummary of Compromise Offer:
$~mount of Future Interest ........................................ $ 68,147.59
· alue of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) ....... $ 0.00
3~alue of Line 1 passing to spouse at appropriate tax rate
Check One ~ 3~--J 0°/~ ........ ' 25,060.05
(also include as part of total shown on Line 15 of Oover Sheet)
· alue of Line 1 taxable at lineal rate
Check One ~C~ 4~-~'1 ............. $ 43,087.54
(also include as part of total shown on Line 16 of Cover Sheet)
· alue of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ....... $ 0.00
6~alue of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ....... $ 0.00
3;otal Value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ................ $ 68,147.59
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1647 EX (Rev. 9-00)
REV-1649 EX + (1/97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert G. flartman Jr.
SCHEDULE O
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
SS# 177-24-7063 11/09/2003
FILENUMBER
21-03-1038
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance &
Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the by- Das s trust, Item TV Will_ Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirement of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule O, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election
to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included
as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or
similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on
Schedule O. The denominator is e~,,,~l to the total value of the trust or similar arran~lement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving
s~useunderaSection9113(A)~ustorsimilararrangement.
DESCRIPTION
1 Hartman & Assoc. stock purchase agreement
(Schedule E, item #1)
Less deductions of $14,479.33
2
Life insurance proceeds from New
Policy No. 0761274 (see attached
England Financial/Met Life
form 712)
made.
Part A Total
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is bein
DESCRIPTION
1 Hartman & Assoc. stock purchase agreement
(less deductions)
VALUE
82,626.92
112,989.96
195;616.88
VALUE
68,147.59
Part B Total 68,147.59
Form REV-1649 EX (Rev. 1-97)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EX(11-96)
NO. CD 004348
SLIKE JOHN E
2109 MARKET STREET
CAMP HILL, PA 17011
fold
ESTATE INFORMATION: SSN: 177-24-7063
FILE NUMBER: 2103- 1038
DECEDENT NAME: HARTMAN ROBERT G JR
DATE OF PAYMENT: 09/07/2004
POSTMARK DATE: 08/31/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $30.74
TOTAL AMOUNT PAID:
930.74
REMARKS:
SEAL
CHECK# 8460
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERTTANCE TAX DIV/STON
PO BOX 280601
HARRTSBURG, PA 17128-0601
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-1G4? EX AFP (09-04)
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
PA 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-15-Z00~
HARTNAN JR
11-09-2005
21 05-1058
CUMBERLAND
101
Amount Remitted
ROBERT
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HARTMAN JR ROBERT G FILE NO. 21 03-1038 ACN 101 DATE 11-15-200~
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
5. Closely Held Stock/Partnership Interest (Schedule C)
~. Hortgages/Hotes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
0O
00
00
00
87;126.92
2;332.22
126;666 5~
NOTE: To insure proper
credit to your account,
sub. it tho upper portion
of this form with your
tax payment.
216,125.68
APPROVED DEDUCTIONS AND EXEMPTIONS: 1~,~79.33
9. Funeral Expenses/Ad.. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgege Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11)
12. Net Value of Tax Return (12)
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
lq. Net Value of Estate Subject to Tax (1~)
NOTE:
If an assessment vas issued prev/ously, 1/nas 14, 15 and/or 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate
16. Aeount of Line 1~ taxable at Lineal/Class A rate
17. Amount of Line lq at Sibling rate
18. Amoun~ of Line lq taxable a~ Collateral/Class B rats
19. Principal Tax Due
TAX CREDITS:
PAYflENT RECEIPT DISCOUNT
DATE NUHBER INTEREST/PEN PAID (-
02-06-2001 CD005516 105.26
08-$1-200t CDOOi$18 .00
INTEREST IS CHARGED THROUGH 11-$0-200~
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
152,892.70 X O0 =
~8,75~;~3 x 0t5 =
o.o x =
::00 x 15 =
: (~)=
AHOUNT PAID
$ 0 '
(15)
(16)
(17)
(lB)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1~.179.33
201,6~6.$5
.00
201,6t6.$5
18 and 19 will
.00
Z,195.91
.00
.00
'Z,195.91
2,136.00
57.91
.79
58.70
IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in tho estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after tho expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateral) rate on any such future interest.
To fulfill tho requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (7Z P.S.
Section 91q0).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLS~ AGENT
A refund of m tax credit, which was not requested on the Tax Return, may bo requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-Z313). Applications are available
online at www.revmnua.state.oa.us~ any Register of Nills or Revenue District Office, or from the Department's
Z4-hour ansaoring service for forms orders: 1-800-262-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT
Any party in interest not satisfied with the appraismont, allowance or disallowance of deductions or assessment of tax
(including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA Department of Revenue, Board of Appeals. You amy object by filing a protest online at
www.boardofappeals.state.pa.us on or before the expiration of tho sixty-day appeal period. In order for
an electronic protest to bo valid, you must receive a confirmation number and processed date from tho
Board of Appeals wsbsite. You Bay also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be foxed.
B} Election to have the matter determined at tho audit of the account of tho personal representative.
C) 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, P.O. Box Z80601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Ssa page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-lEO1) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after tho decedent's death, a five percent (5Z) d[scount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after tho end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the sams tiao 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 tho date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum caIcuIatad at a daiIy rate of .000164. AIl taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which wi1! vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor Year Rate
~ lOX . 000548 ~'~- 1991 111 .OOO:~O1 2001 91
1983 162 . 000q38 1992 9X . 000247 2002 67.
1984 111 .000301 1992-1994 71 .000192 Z002 SZ
1985 122 .000356 1995-1998 97. .000247 2004 47.
1986 lOX .000174 1999 77. .000192
1987 lOZ .000274 ZOO0 77. .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
Daily
Factor
.000147
.000164
.000137
.DO0110
--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 the
Notice, additional interest must be calculated.
BUREAU OF TNDTVZDUAL TAXES
TNHERZT. ANCE TAX DTVTSTON
DEPT. Z80601
HARRISBURG, PA 171Z6-0601
DANIEL J HARTMAN
127 S 15TH
CAM~HILC PA 17011
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
DATE 12-10-2004
ESTATE OF HARTMAN JR
DATE OF DEATH I1-09-Z005
FILE NUMBER
COUNTY
SSN/DC
ACN
21 05-1058
CUMBERLAND
177-24-7065
04106285
Amoun'~ Remi.¥ced
REV-160¢ EX AFP C01-03)
ROBERT G
-~.} ~-_ ~- ~C~ HAKE CHECK PAYA~tLE AND REMIT PAYMENT TO:
~ ~ OOC*~ REGISTER OF WILLS
:~;:~:: h ~ CUH~E"LAND CO COURT HOUSE
c~'--: ~= CARLISLE, PA 1701~
..... .... ..... .....................
REV-1604 EX AFP (01-03)
~ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS
DATE 12-10-2004
ESTATE OF HARTMAN JR
ROBERT G DATE OF DEATH 11-09-2005 COUNTY
CUMBERLAND
FILE NO. 21 03-1058 S.S/D.C. NO. 177-24-7065 ACN 04106285
ADJUSTMENT RASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK ACCOUNT NO.
10010684
TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 05-10-199q
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions -
Taxable Amount
Tax Rate X
Tax Due
TAX CREDITS:
.00 NOTE:
0.166
.00
.O0
.00
.00
TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE HZTH YOUR TAX
PAYMENT TO THE REGISTER OF HILLS
AT THE ADDRESS SHOHN ABOVE.
HAKE CHECK OR HONEY ORDER PAYABLE
TO: "REGISTER OF HILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF pATD AFTER THIS DATE, SEE REVERSE FOR CALCULAT/ON OF ADD/T/ONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT TS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTTONS.)
.00
.00
.00
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME FILE NUMBER
ROBERT G HARTMAN 2103-1038
REVIEWED BY ACN
Phyllis Hoch 04106285
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
ADJUSTED ABOVE ACN TO ZERO, REPORTED ON PROBATE RETURN, TRANSFERRED
PAYMENT FROM ABOVE ACN TO PROBATE RETURN.
ROW Pa.qe 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL ~tD~[:~ OFFICE OF
TNHERTTANCE TAX DTVTSTON
PO Box z&o60~ ~.~_', ~[ , r"*'~ *~ ~q t ~
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP {09-0~)
200q DEC 29 AH 9:12
CLERK OF
ORPHAN'S COURT
DANIEL ,,.~L~lq.~',,lO OOp , ~r
127 S 15TH
CAMP HILL PA 17011
DATE 1Z-13-Z00q
ESTATE OF HARTMAN JR
DATE OF DEATH 11-09-2005
FILE NUMBER 21 05-1058
COUNTY CUMBERLAND
ACN 0q106285
Amoun'l: Rem J.~:ed
ROBERT G
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your accoun~c, submi~ ~he upper portion of ~his fore wi~ch your ~ax payeen~.
CUT ALONG THIS LTNE I1~ RETAIN LOWER PORTION FOR YOUR RECORDS ~11
R~?-':~&5~'i~' ';PP' 'i'ST'-'~l ...... ';;; ':~r&q~ 1'Aq;~:~' 'fR~ '~ ?~YI~ R~qTf' ~1~ ';;~:Y~0r~ ' ' ;~'; .....................
ESTATE OF HARTMAN JR ROBERT G F'rLE NO. 21 05-1058 ACN 0q106285 DATE 12-15-200q
THTS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO~/N BELOW/
IS A SUMMARY OF THE PRINCIPAL TAX DUE., APPLICATION OF ALL PAYMENTS., THE CURRENT BALANCE., AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-09-200q
PRINCIPAL TAX DUE: ...........................................................................................
PAYMENTS (TAX CREDITS):
.00
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REgUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDZT" (CR),
TOTAL TAX CREDIT .00
IALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
CONMONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
BUREAU OF ZNDIVZDUAL TAXES N~ ,~l)~r6:P~ ~NHERZTANCE TAX
PO BOX 28060!
EHENT OP AG¢OUNT
REV-'I~O7 EX AFP
JOHN E SLIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
2Ol:lt~ [lEO 29 ¢,I'I 9:
CLER','( OF
ORPHAN'S COURT
PA 17011
DATE 12-15-200q
ESTATE OF HARTMAN JR
DATE OF DEATH 11-09-2005
FZLE NUMBER 21 05-1058
COUNTY CUMBERLAND
ACH 101
Amoun~ Rem,J.~ed
ROBERT G
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To ~nsure proper credi~ ~o your account, subm~ ~he upper potation of ~his form ff~h your ~ax peymen~c.
CUT ALONG THZS LZNE I~' RETAZN LONER PORTZON FOR YOUR RECORDS ~11
ItW-' :~r,~Y '[~C '~;Pir '~i~I.'-'6~1 ...... ';~' 't~r~if~ YA~IE~' 'f~'x' ';t~¥~it~f ' ~Y ';i~Y~0~' ' ~; .....................
ESTATE OF HARTMAN JR ROBERT G F'rLE NO. 21 05-1058 ACN 101 DATE 12-15-Z00~
THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELOt/
TS A SUNHARY OF THE pRTNCTPAL TAX DUE, APpLTCATTON OF ALL PAYMENTS,, THE CURRENT BALANCE., AND, TF APPLTCABLE,,
A PROJECTED TNTEREST F[GURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-15-200~
PRINCIPAL TAX DUE: ...........................................................................................
PAYMENTS (TAX CREDITS):
2,195.91
PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAZD (-)
02-06-200~
05-09-200~
08-$1-200~
~,CD0055~6
~ CD005690
~ CD00~$~8
105.26
.00
.00
2,000.00
57.91
$0.7fi
ZF PAZD AFTER THZS DATE, SEE REVERSE
SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYNENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR),
TOTAL TAX CREDZT
2,195.91
· ALANCE OF TAX DUE .00
ZNTEREST AND PEN. .07
TOTAL DUE .07
YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR ZNSTRUCTTONS.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Robert G. Hartman, Jr.
Date of Death: November 9, 2003
Will No.
21-03-1038
Admin. No.
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:
complete:
1. State
Yes ~i
whether
No
administration
of
the
estate
is
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:
c. Did the personal representative state an
account informally to the parties in interest? Yes ~i No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date:
). /z s 7) 5'
I
"\ C ~I
(;i~l~'{~~~J It.k_-/rJ)
Name: John E. Slike, Esquire
,J.D. No. 06262
SAIDIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
('--.I
,:,""')
Capacity:
Personal Representative
r--..
x Counsel for Personal Representative
(---.J
uf
--','- i'\f\ r...,t.-., ,._,...., :'-"\-
BUREAU OF INDI~~A!4\!~'tES,J-
INHERITANCE TAX DIVISI,(lK.."'"
PO BOX 280601 , .. .... .
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-1607 EX AFP 112-00
?O
...J
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-14-2005
HARTMAN JR
11-09-2003
21 03-1038
CUMBERLAND
04106285
Allount Rellitted
ROBERT
G
DANIE(!j
127 S 15TH
CAMP HILL
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~~:r~~".I5r.A'~..r81~if!'........;..:rA~!~~~1r~l5r.~'A1f!~.b".l~l:60~...j(..........._..........
ESTATE OF HARTMAN JR ROBERT G FILE NO.21 03-1038 ACN 04106285 DATE 02-14-2005
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-09-2004
PRINCIPAL TAX DUE:,
.00
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
IE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
BUREAU OF INDIVIDUAl~:r~X.~
INHERITANCE TAX DIVISION'
PO BOX 280601 .
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-ln7 EX iFP 112-041
I"'-,.t'""\
L'j
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-14-2005
HARTMAN JR
11-09-2003
21 03-1038
CUMBERLAND
101
Allount Relli Heel
ROBERT
G
JOHN E StIKE
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subnit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
IW:1'gtJ".!Y.A'~"..rlll-='.6J".......;..YAffWfn"tter"'AY.~nYlAwr.bV.X~b"'60Fff...."'.................. ...
ESTATE OF HARTMAN JR ROBERT G FILE NO.21 03-1038 ACN 101 DATE 02-14-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-15-2004
PRINCIPAL TAX DUE:.
I.____.....""IIIII''I.II"'JJ_
2,193.91
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-06-2004 CD003546 105.26 2,000.00
03-09-2004 CD003690 .00 57.91
08-31-2004 CD004348 .00 30.74
TOTAL TAX CREDIT 2,193.91
BALANCE OF TAX DUE .00
INTEREST AND PEN. .07
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .07
II
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
vnll MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l