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15056041125
REV-1500 EX (06.05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of IndNidual Taxes County Code Year File Number
Po Box zeosol INHERITANCE TAX RETURN 2 1 0 9 0 0 8 7
Hamisbum PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 7 1 6 1 2 5 2 0 1 1 9 2 0 0 9 0 1 1 0 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
HER T Z L E R W I L L I A M T
(If Appiiwble) Enter Surviving Spouse's Information Balow
Spouse's Last Name Suffx Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82) 0
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOI
Name Daytime 7e
M A R K A MAT E Y A E S Q U I R E 7 1 7
Finn Name (If Applicable) REGI
M A T E Y A LAW F I R M
First line of address
P O B O X 1 2 7
Second line of address
City ar Post Office State ZIP Code ~-_~ -
B O I L I N G S P R I N G S P A 1 7 0 0 7
Correspondent's a-mail address: MAM@MATEYALAW.COM
\TIQN SHOULD BEAI~EGTED TO:
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DATE FILED_ __
Under penahies of perjury, I declare Mat I have examined this 2Nm, inducting acampsnying schedules and statements, and to the best of my knowle~e and belie4
8 is 4ue, coned and complete. DedareBon of preparer other than the personal represenfa8ve rs based on all InfonnaGon of which preparer has any knowledge.
SIGNATURE OF PERSON RESP SIBLE ILING RETURN ~ ~gnTE
24$ LENDALE STREET l _ CARLISLE PA 17013
SIG UR OF REPA /~R THAN REPRESENTATIVE DATE
P 0 BOX 127 BOILING SPRINGS PA 17007
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125 15056041125
,F ,
J
15056042126
REV-1500 EX Decedent's Social Security Number
WILLIAM T. HERTZLER 1 7 7 1 6 1 2 5 2
DecedenCS Name:
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1
7 9 4 0 8 3 6 4
2. ................................
Stocks and Bonds (Schedule B) .. 2. ,
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3.
4. Mortgages & Notes Receivable (Schedule D) ...................... .. 4.
2 7 8 4 1 4 , 3 2
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 1 1 7 0 0 0 0 0
(Schedule G) ~ Separate Billing Requested .... ... 7. ,
8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 1 1 8 9 4 9 7, 9 6
9 3 2 1 9 0 , 9 0
9. Funeral Expenses & Administrative Costs (Schedule H) ............. .
...
1 2 6 5 1 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... ... 10. ,
11. Total Deductions (total Lines 9 & 10) ........................ ... 11. 3 3 4 5 6 , 0 7
12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. 1 1 5 6 0 4 1 , 8 9
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an eledan to tax has not been made (Schedule J) ............... ... 13.
1 1 5 6 0 4 1 8 9
14. Net Value Subject to Tax (Line 12 minus Line 13) ......... .. ..... .. 14. ,
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable 1 1 5 6 0 4 1 8 8 5 2 0 2 1, 8 8
at lineal rate X .045 16.
17. Amount of Line 14 taxable
0
0
0
0
0
0
at sibling rate X .12 17. ,
18. Amount of Lina 14 taxable
0
0
0
0
0
0
at collateral rate X .15 , i 6 ,
19. Tax Due ................................................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
5 2 0 2 1, 8 8
Side 2
L 15056042126 15056042126 J
REV-1500 EX age 3 File Number
~~cedent's Complete Address: 21 Os oos7
DECEDENT'S NAME
WILLIAM T. HERTZLER
STREET ADDRESS
1000 W SOUTH STREET
CITY 1 STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
t. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Povedy Credit 0.00
B. Pdor Payments 47.000.00
C. Discount 2,473.68
3. InteresUPenalty if applicable
D. Interest
E. Penally
(1) 52,021.88
Total Credits (A + g +C) (2) 49,473.68
Total InteresUPenalty (D+E) (3) 0.00
If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT.
FNI in oval on Page 2, Line 20 to request a refund.
5. If Line 1 +Line 3 is greaterthan Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(4) 0.00
(5) 2,548.20
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (58) 2, 548.20
Make Check Payab/e to: REG/STER OFW/LLS, AGENT
I u~I r,F3{](lf~'~i1,Pri~*hi'~.,~~`.~.~#'1~.~v~rks,:vv,t ,i.i~K,~~~»t44±i'. ..ri i5 ~.t '~L ti..)„i:._`i.~~l. i~i~'L,`4.,i;C.4t3~,i,E.1"~i~)~hS l;.rjf~))~~~.;;~IlEiili3{~l~?,h'i<Lak'v13f ~Ii ll.!I~~.&~~'~,t~t6,unit,?~l{°:autlbk,i~.~1,~,.u, i
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1N 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 propedy transferred or its income : ........................ ..... ^
c. retain a reversionary interest; or .......................................................................................... ...... ^
^ ^X
d. receive the promise for life of either payments, beneflis or care? ................................................. ......
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. ...... ~ ^
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... ...... ^ 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................ ...... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE n AS PART OF THE RETURN.
. s .. . ~ .. .. ,., ,. .. .. ... ... , .
i~.)~,I!vl, ~~(nE l~t „#;a~ a::4, ,i .. .. ., _. ~ .1iq "I,: '. .ts,~..>„ ''.
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 [/2 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 (O) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
fling 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 childtwenty-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 benef ciades is four and one-half (4.5) 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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in comrtwn with the decedent, whether by blood or adoption.
REV-1503 EX t(&98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WILLIAM T. HERTZLER 21 09 0087
All property joindyowned srith rlgM of survWorship must be discbsed on SchedWe F.
ITEM VALUE AT DATE
NUMBER -DESCRIPTION OF DEATH
CALVERT INCOME FUND
881.5000 SHARES -MEAN $13.75
2. WACHOVIA SECURITIES 26,223.48
CAPITAL INCOME BUILDER
669.1370 SHARES -MEAN $39.19
3. WACHOVIA SECURITIES 20,090.00
CARLISLE COMPANIES
1000 SHARES -MEAN $20.09
4. WACHOVIA SECURITIES 32,336.12
EVERGREEN EQUITY TR
3682.9290 SHARES -MEAN $8.78
5. WACHOVIA SECURITIES 8,169.27
FIRST EAGLE SOGEN FUNDS
532.2000 SHARES -MEAN $15.35
6. WACHOVIA SECURITIES 9,760.79
GABELLI SMALL CAP
527.3250 SHARES -MEAN $18.51
7. WACHOVIA SECURITIES 45,560.00
JP MORGAN CHASE & CO
2000 SHARES -MEAN $22.78
8. WACHOVIA SECURITES 8,210.03
NUVEEN INVT TRUST
801.7610 SHARES -MEAN $10.24
9. WACHOVIA SECURITIES 12,010.00
PEABODY ENERGY CO
500 SHARES -MEAN $24.02
10. WACHOVIA SECURITIES 57,070.00
RUSSELL INVST CO
57970 SHARES -MEAN $1.00
11. WACHOVIASECURITIES 50,968.20
VAN KAMPEN 303
60 SHARES -MEAN $849.47
12. WACHOVIA SECURITIES 65,687,58
VAN KAMPEN 304
74 SHARES -MEAN $887.67
13. WACHOVIA SECURITIES 43,042,00
VAN KAMPEN 305
50 SHARES -MEAN $860.84
14. WACHOVIA SECURITIES 86,676.10
VAN KAMPEN 311
98 SHARES -MEAN $884.45
15. WACHOVIA SECURITES 89,877.00
VAN KAMPEN 312
100 SHARES -MEAN $898.77
16. WACHOVIA SECURITIES 44,591.50
VAN KAMPEN 314
50 SHARES -MEAN $891.83
TOTAL (Also enter on line 2, Recapitulation) S 794.083.64
(If more space is needed, insert addNOnal sheets of the same size)
~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent
WILLIAM T. HERTZLER 21 09 0087
DecedenPs Name Page 1 File Number
Schedule B -Stocks & Bonds
ITEM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
17. WACHOVIA SECURITIES 49,532.50
VAN KAMPEN 280
50 SHARES -MEAN $990.65
18. WACHOVIA SECURITIES 39,443.47
VAN KAMPEN 308
43 SHARES -MEAN $917.29
19. WACHOVIA SECURITIES 92,714.97
VAN KAMPEN 306
101 SHARES -MEAN $917.97
SUBTOTAL SCHEDULE B 181,690.94
GRAND TOTAL SCHEDULE B S 794,083.64
REV-1508 EX)+ (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
WILLIAM T. HERTZLER 21 09 0087
Include the proceeds of 1'Itigadon and Ne date Ne proceeds were received by the estate.
All props joirlttyowned vAM right of survNorship must he discbsed on 5chadub F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. WACHOVIASECURITIES 51,112.24
MONEY MARKET ACCOUNT
2. THE ROYCE FUNDS 107,080.91
TOTAL RETURN FUND
FUND NUMBER 267 -ACCOUNT NO. XXXX6292
3. THE ROYCE FUNDS 430.79
DIVIDEND CHECK
FUND NO. 267 -ACCOUNT NO. XXXX6292
4. UNITED CHURCH OF CHRIST HOMES 2,683.56
ASSISTED LIVING REFUND
CHECK NO. 050793
5. ORRSTOWN BANK 17,376.70
CHECKING ACCOUNT
ACCOUNT NO. XXXXX1725
6. THE ROYCE FUNDS 492.33
TOTAL RETURN FUND
DIVIDEND FOR ACCOUNT NO. XXXX6292
7. EMBARQ 7.56
TELEPHONE/CABLE SERVICE
REFUND
8. BNY MELLON 96,660.04
ACCOUNT NO. XX)(XXXXXBNY7
9. BNY MELLON 4.37
ACCRUED INTEREST ON ACCOUNT
ACCOUNT NO. XXXXXXXXBNY7
10 CAPITAL BLUE CROSS 430.82
REFUND OF INSURANCE PREMIUM
CK 330019300
11. WESTMINSTER CEMETERY 2,135.00
PRE-PAID FUNERAL EXPENSES
TOTAL (Also enter on line 5, Recapitulation) ~ S
(If more space is needed, insert add'Nonal sheets of the same size)
REV-1513 EX~+ (8-e8)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
WILLIAM T. HERTZLER 21 09 0087
This schedule must be completed and filed it the answer to any of questions 1 through 4 on the reverse side o(the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRiPT10N OF PROPERTY
irvcwoe~xe wort orlxe maxsvEpeE, Txexagnnausxir ro oreEOxx*nao
TMEC^^*E Orranesvew nnncxncow or ixe oeeo Fax xFx esrnrt.
DATE OF DEATH
VALUE Of ASSET
%OF DECD'S
INTEREST
EXCLUSION
prnPpiGBLq
TAXABLE
VALUE
t. CASH GIFTING - 10/16/2008 25,000.00 100. 3,000.00 22,000.00
JANICE HERTZLER
DAUGHTER
2. CASH GIFTING - 10116/2008 25,000.00 100. 25,000.00
ROBERT HERTZLER
SON
3. CASH GIFTING - 7/2/2008 35,000.00 100. 35,000.00
JANICE HERTZLER
DAUGHTER
4. CASH GIFTING - 7/2/2008 35,000.00 100. 35,000.00
ROBERT HERTZLER
SON
TOTAL (Also enter on Tine 7 Recapitulation) I E 117,000.00
(It more space is needed, insen additional sheeLa of the same ske)
REV-15;j EXp (12-99)
a
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES 8r
ADMINISTRATIVE COSTS
ESTATE OF rat nursoerc
WILLIAM T. HERTZLER 21 09 0087
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
t. HETRICK FUNERAL HOME 173.00
2. WESTMINSTER CEMETERY -INTERMENT FEES 2,535.00
3. HETRICK FUNERAL HOME -OBITUARY NOTICE, CREMATION CONTAINER, ETC. 665.51
4. L&D CATERING, INC -AFTER FUNERAL MEAL 890.40
5. ANNA THOMPSON -PASTORAL SERVICES 125.00
B. ADMINISTRATIVE COSTS:
t, Personal Representative's Commissions
Name of Personal Repnxentative (s)
Sodal Secudly Number(suEIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
p, AttomeyFees MATEYALAWFIRM
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
( laimant
Street Address
Ciry State _
Relatlonshlp of Claimant to Decedent
4. ~ Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
5 Accountant's Fees
6. Tax Rehm Preparels Fees BOYER & RITTER CPA PREP OF 2008 PERSONAL
INCOME TAX RETURNS
7. CUMBERLAND LAW JOURNAL -LEGAL ADVERTISEMENT
8. THE PATRIOT NEWS -LEGAL ADVERTISEMENT
26,000.00
764.00
690.00
75.00
272.99
TOTAL (Also enter on line 9, Recapitulation) I E
Zip
Zip
more space is needed, insert additbnal sheets of the same size)
RE~151'f EX it (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCNEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
WILLIAM T. HERTZLER 21 09 0087
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unroimbursad medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MILLENNIUM PHARMACY 1,074.53
PRESCRIPTION MEDICATIONS
ACCT NO. STMH1332
2. MILLENNIUM PHARMACY 53.08
PRESCRIPTION MEDICATIONS
ACCT NO. STMH1332
3. CARLISLE BOROUGH 4.90
2009 PERSONAL TAXES
ACCOUNT NO. 002-004133
4. SPRING ROAD FAMILY PRACTICE 7893
MEDICAL SERVICES
5. PHILHAVEN 53.73
MEDICAL SERVICES
TOTAL (Also enter on line 10, Recapitulation) I E
space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
WILLIAM T. HERTZLER
1, William T. Hertzler, a legal resident of Carlisle Borough, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby make,
publish, and declare this as and for my Last Wiil and Testament, hereby revoking all other wills and
codicils heretofore made by me.
FIRST: I direct that all my just debts and funeral expenses, including my grave
marker, shall be paid from the assets of my estate as soon as practicable after my decease.
SECOND: 1 direct that all taxes that may be assessed in consequence of my death, of
whatever nature and by whateverjurisdiction imposed, shelf be paid from my residuary estate as a
part of the expense of the administration of my estate.
TH1RD: I devise and bequeath the residue of my estate, of every nature and wherever
situate, to my children,lanice E. Hertzler and Robert H. Hertzler, equally, provided that the share
of any child who predeceases me or dies on or before the thirtieth day following my death shall be
added to the share for my other child and shall not be distributed per stirpes.
FOURTH: I nominate, constitute and appoint my daughter, Janice E. Hertzler, Executrix,
ofthis, my Last W ill and Testament. In the event of the renunciation, death, resignation, or inability
to act for any reason whatsoever of my daughter,l nominate, constitute, and appoint my son, Robert
H. Hertzler, Executor, ofthis, my Last Will and Testament. I hereby relieve my Executrix or her
successor from the necessity of posting security in connection with their duties as such in any
jurisdiction in which they may be ca{led upon to act, insofar as I am able by law so to do.
IN WITNESS WHEREOF, 1 have hereunto set m~ hand and seal to this, my Last Will and
Testament, consisting of one typewritten page, this 6 ~ day of April, 2006.
William T. Hertzler, Testate
Signed, sealed, published, and declared by the above-named Testator, William T. Hertzler,
as and for his Last Will and Testament, in the presence of us, who, at his request, in his sigh[ and
presence, and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
_~
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
I, William T. Hertzler, Testator, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that 1 signed and
executed the instrument as my Last W i11; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
worn or affirmed to and acknowledged before me by William T. Hertzler, theTestator, this
_~ ~! day of April, 2006.
William T. Hertzler, Testator
~~i~~ g~~~~C~~~~~~
Notary Public
AFFIDAVIT Notarial Seat
Pamela R. Knowlton, Notary Public
COMMONWEALTH OF PENNSYLVANIA ) Carlisle8orough, CumbedendCounty
AAy Commission Expires November 9, 2005
COUNTY OF CUMBERLAND
We, Edward L. Schorpp and e~r+E.PA~ L~~.+ra9DS ,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 sign and execute the instrument as his Last
Will; that William T. Hertzler signed willingly and that he executed it as his free and voluntary act
for the purpose 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 or
more years of age, of sound mind, and under no constraint or undue influence.
Swom or affirmed and subscribed to before me by Edward L. Schotpp ante
~. ~/o~DS ,witnesses, this~~` day of April, 2006.
~~='~i''`~ '-'i~Z~~~ (SEAL)
Witne~ Edward L. Schorpp
Notary
~ ~~~ NUl,vial SHAT ~-~_ ~ ~
'~%~mAIA N. K:tnwllon. NOtdfy PUU1,~ '