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Home My WebLink About12-09-09J Soaal Security Number 204-0&7677 Decedent's Last Name Hartman Date d Deattr Date d Birth 05/09/2006 02/09/1921 Suffi>< Decedent's Firet Name Carl (MAPPSCabla) Erdsr Survlvllg spouse's Inrornutbn Below Spouse's Last Name Su18x Spouse's First Hama wA Spouse's Soda! Secufty Number MI B MI THIS RETURN MUST BE BLED IN DUPLICATE WRH THE FlLL IN APPROPRIATE ovALa BELOW REGISTER OF WILLS ~ 1. Original Return ;~ 2. Supplemental Return O 3. RemNrWer Ratum (dab d deaM G~J 4. Limited Esata O 48. FuWre Interest Compernbe (dated prbr b 12-13-tt2) deaM after 12-12-82) `~ 5. Federal Estate Tax Return Required ~ 8. Deredant Died Taeteb CM.I 7. Dscetlerd Mairrbined a Livi Trust 0 (Attach Copy d V1ell) (Attach Copy d Trwt) rrB _. - ... 8. Trial Number d Sete OeCoek Boxes C> 9. LiBpetlon ProcaeUe Received ~ 10. Spousal Povary Credit (dale d death CJ 11. EbWOn b tax urMer Sec. 9113(A) txawaen 12-31-91 and 1-1-95) (ptbdr ~. O) rneeree......r _ __-- -. _••••~... - ~-e seen Name VYlliam C Anderson Firm Name (If APpNcable) Anderson Converse & Fen First Ifne d address 1423 East Market St Saoorrd Nne d address City or Poet Omoe York Cdreaponderd's e-mell MUST 0E OOMPLETED. ALL DORRESPDNDENCE AND CONFlDENTUIL T AX SItY)RMi-TNNI SHOULD BE DStECTED T0: DBYDme Telephone Number (717)846-7100 ___ _ REGISTER OF N7LLS USE ONLY _. _ N n o .v r;0 t~ -~, c'~~ci rn u 7 c'~ ~ rr1 t n' I -- t w: a oc~c~ a tir -~-n .1C DA7~~L Sbb LP Code .. E D -~ r; ~ _;_~ -> _. _ ,x i ._ .~ PA 17403 _v-i p .. r1 ~-'`- r N atlw tlren 3601 Sullivan PA 17050 b ADDRESS 1423 East Market Street York PA !7403 L_ 15056051058 15056051058 REV-1500 Ex (os-os) PA DsParlnNnt d Revenue BuseY d plAeidtal Tams oFFlclAt INJE ONLY PoBOxzeaeol County Code Year Fib Number INHERITANCE TAX RETURN Nrdrbury, PA 1T12t40801 RESIDENT DECEDENT 21 06 476 YT INFORMATION BELOW _ Side 1 15056051058 y l~ t V_ .~ 15056052059 REV-1500 EX DecedenPS Social Seaxiry Number De~aerxs ~: Cad B Hartman 204-03.7677 RECAPITULATION '-- - ---_. ---...__ 1 . Reel eabb (SchedrAe A) .......................................... ... 1. 193,520.00 z. Stocks and Bonds (Schedub e) .................................... ... z. ... 0.00 ... .... 3. Closely Held Corporation, Partnership or Sob-ProprielomhlP (Sd~eAule C) .. ... 3. .. 0.00 _ 4. Mortgepes 6 Notes Receivable (Schedule D) ...................... . ... ... 4. ... 0.00 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ... 5,265.00 . .. 6. Jokgry owned Property (Schedule F) o Separate 81Nrg Requested .... ... s. 14,792.96.. 7. Inter-Vivoa Trarefera 6 Misoe%aneous Non-Probate prgieAy _. ...... ....... (Schedule G) o separate BYlkrg Requested..... ... T. ... 1,723,940.41. 8. Total Gross Asssts (bbl Lines 1-7) ................................. ... 8.. 1,942,918.37 9. Funeral Expenses & Adrrrlnlatratlve Costs (Schedule H) .................. ... 9. ...._ .. ......_ ... 23,765:90 ............ 10. Debts of Decedent, Mortgage Liabilitles, & Lbns (Schedule I) ............. ... 10. . 11. Tow Daductlons (total Lines 9 a 10) ................................ ... 1L . , _. . ...... 23,765.90 ._, 12. Nat Valus of Estab (LMe 8 mhos Line 11) ........................... ... 12. 1,919,152.47 13. CheribWe and Gwermnental Beque&s/Sec 9113 Trusts for which ... ...... - an ebdan b taz has rat peen made (Schedule J) ...................... .. 13. _ 14. Nst Valve SubJact tb Tax (Una 1z minus Line 13) ...................... .. 14. 1,919,162.47 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES _ 15. Mount of lJne 14 taxable at the spousal tax rate or perrafers under Sec. 9118 (ax12) X .0_ 15. 18. Amount of Line 14 faxede ....... at lNeat rate x.04i'i 18. 1,919,152.47 17. Amount of Une 14 taxable _... _.. .. at aiplkrg rate x .1z 17. 18. Arrarxrt of Line 14 fazabb _ _ _. . _. _. at oolleteral rate X .15 18. . 19. TAX DUE ....................................................... .. 19. . 66,361.86 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .~ 15056052059 Sida 2 t_ 15056052059 '~ COMMONWEALTH OF PENNSYLVAN41 INHERDANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS All property JolMlyownad wltll rlpM of auMvonMP nwat M ~acloaee on BcMeule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ .,___ OF DEATH TOTAL (Also enter on line '' coMMONwEALT}t OF PENNSnvAN1A SCHEDULE C INHERRANCE TAX RETURN RESIDENT DECEDENT CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP Schetlule C-t or G2 (Mdudinp aN wpporlirtp iMOlmeNon) muq 1X! attached tar each closely-Held corparetiorVpartnerehip interest of the decedent, ON18r than a sok- See instructlons M1x the supporlNg Inblrnaeon b 1!e wtXniNed for ede-progietashlpa ProPlietorehip. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Nona TOTAL (Also enter on line 3, COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT 1. Name of Corporation State of Incorporation Address Date of Incorpoation Csy State ZIP Code Total Number of Shalahoklers 2. Federal Empbyer I.D. Number Business Reporting Year 3. Type of Business ProducUServioe 4. 5. 6. STOCK TYPE Votirg/NOn-VOOng TOTAL NUMBER OF SFWRES OUTSTANDING PA NUMBER OF SHARES VALUE OF THE R VALUE OWNED BY THE DECEDENT DECENDENPSSTOCK Common Preferred Was the decedent empkyred by the Corporation? ^ Vas ^ No Byes' Posdwn Annual Salary Was tha Corporation intlebted to the decedent? ~ Yes ~ No F'rovae all dghls and restrictlons pertaining to each pass of stock, B yea, Provide the amount of the indebtedness 7. Was there life insurance payable to the caporatbn upon the death of the decedent? yep H yes, Cash Surrender Value Owner of the policy Nat proceeds payabb Time Devoted to Business ^ No 8. ~ ~ d ~ No ~Illf ~ osier s ~ ~n~ pay ~b one 1 ~u bar a S ae~r within [wo years 'rf tha date of death was prior to 12-31-82? Transferee or Purchaser Consideration Attach a saperate arleet to addPoOnal transkva arld/ar sale9 9. Was there a written shareholder's agreement in effect at the tkne of the decedent's death? ~ Yes ^ No B yes, Provide a copy of the agreement. 10. Was the daoadents stack sold? ~ Yes ~ No B yes, Provide a copy of the agreement of sale, etc. 11. Was the corpoation dissolved or Ipuidated after tha decedent's death? ^ Yes ^ No If yes, provide a breakdown of distrtbu8ons received by the estate, inGuding dates and amounts received, 12. Did the corporation have an interest in other corporetbns or partnerships? ~ yes ~ No B yes, report the necessary iMOrmation on a separate sheet, induding a Schedule G1 or C-2 for each interest Date B. Complete copies W financial statements or Federel Corporate Income TeX retlrms (Form 1120) for the year of death and 4 preceding years. C. If the corporation arced real estate, subm8 a list showing dre campbta addrass/es and es8mated fair market vakre/s. B real estate appraisals have D. L~ of~pri~nci~Pal~od ho~lder~s~at the date of death, number of shares hakl and their rela0onship to the decedent. E. LFSt of officere, their salaries, tronuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information rela8ng to the valuation of the decedent's stock ~' COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT 1. Name of Partnership None Dale Busies ~~~ Address Business Reporting Year Cdy State Zip Code 2. Federal Fmpbyee I.D. Number 3. Type of Business Produd/Service 4. Decedent was a ~ General ^ Lirriled par6ier. tideoederd \tes a irrl'ted partrter provide iitial irn~shrlerk 5. 6. Value of the decedent's interest 7. Was the Partnership indebted to the decedent? If vas. provide the amount of the indebtedness ^Yes ^No B- Was there life insurance oavable to the partnership upon the death of the decedent? Yes ^No Owner of the policy ~In1 n...nnnAn nn.~nAln 9. Did the decedent sell or transfer an in this Partnership wktrin one year prior to death or wi8dn lxro 12-31-8'19 years if the dale of death was prior to ^Yes ^ Na Yves. ^ Transfer ^ Sale Percentage tren ferred/ Transferee or Purchaser s sold Attach a separate sheet for additional transfers and/or sales Consideration Date 10. Was there a written partnership agreement in effect at the time of the decedents death? ~ Yes ~ No If yes, provide a copy of the agreement. 11 • Was the decedent's partnership interest sold? Yes ~ No If yes. provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? Yes ~No If yes, provide a breakdown of distributions received by the estate, induding dates and amounts received. 13. Was the decedent related to any of the partners? Yes ~ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? Yes No If Yes, report the necessary information on a separate sheet, induding a Schedule C-1 or C-2 for each interest A. Detailed calculations used in the valuations of the decedents partnership interest. B. Complete copies dfrrandal sfalemerrts or Federal Partrrershp Irrconre Tax rehxrte arm 1 C. If the partnership owned real estate, submit a list showing the complete address/es~ estimated fair ama ~ valrea~l estate ^ aPPreisels have been secured, attach Copies. COMAgNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDEM SCHEDULE D MORTGAGES & NOTES 21.0678 All property )dolly-owned wHh the right of wrvWOnhip must be dlselosed on ScMdula F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Nona OF DEATH line coM-wNwEKrHDFreNNSn.vnNU SCHEDULE E RESN~MDECEDRE~Rn CASH, BANK DEPOSITS, Fr MISC. ~_ _ _ PERSONAL PROPERTY rx~,aemepooe«Isar~monananemlemeaooeedsMeerec~veaq.u,ewma ulp~op,nrl~rowrwa.wnurrlyeas~.wYO,+n4mwee.asaos.amsaeaul. F. ITEM DESCRIPTION 2 11994 Chrysler New Yorker fair condition 3 1998 Oldsmobile Silhouette fair corldidon VALUE AT DATE OF DEATH 1175 2100 more apace ie needed, invert additional sheets of the name coMMONwEALTN OF PENNSYLYANU SCHEDULE F I~RESS~N7 DECEDR E~NTRN JOINTLY-OWNED PROPERTY os-~Ts If an asset was made Jdnt wkhin one year of the decedem's date of dsalh, k must be reported on SDhsduN G. ADDRESS RELATIONSHIP TO DECEDENT SURVNING JOINT TENANT(S) NAME ITEM NUMBER LETTER DATE DESCRIPTION OF PROPERTY FOR JOINT MAOE 4igbp~my aryy~yy~~A ~p~~a %OF DATE OF DEATH TENANT JONiT AMey~peetl /yjpnllyayy „y MMlfl gnunlEer. DATE OF DEATH DECD'S VALUE OF 1. A. ~ .. VALUE OF ASSET INTEREST DECEDENT'S INfERE3T ~,. A .. Haas d17g6,Y.t7e 9, A iT1eA11;84 56: 6bAB.QB. ~!t $ 90 tg6&@3 TOTAL (Also enter on line 8, Recapdulatan) tq~gy gg (k more SDa[g io nwrwlsA i...-.. -www.._-~ _t_W _eu_ _ . CDMMCNWEALTN CF PENNSIIVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY This schedule must be completed and 81ed if the answer to any of questions 1 through 4 on the revaree side of the REV-1500 COVER SHEET is yes. TTEM t)ESCRIP710N OF PROPERTY % OF DECD'S NUMBER '~~OF~TM~~'^TO ncceoelrAwrNe o~reormNNEER. DATE OF DEATH INTEREST EXCLUSION ArrAwACOw osTleo®raR RELL ESr~re. VALUE OF ASSET ~q TAXABLE 1. NnAI~ e...vA..-.. nnnnnn..e~. 2 North American 8000000838 3 North American 8000048784 591541.8 6 100 4 North American 8000000835 504249.4 100 5 North American 8000000033 93456.79 100 8 North American 71000005590 405738.23 100 7 39803 87 400 North American 800048765 103605.82 100 591541.86 504219.4 93458.79 105738.23 39603.87 403605.82 space s needed, insert additional sheets of the same RFV-tst t EX ~ npp~ s A. 8. COAM~ONWFJILTN OF PENNSYLVANIA INHERRANCE TAx RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ITEM DetKs of depderrt must be reporbd ar Schedule I. 1. ROyeYS Flowere _.___._.. __...~.. 820 I I Royers FloeeB 71.02 Old Country Buffet 775.95 187.13 ADMINISTRATIVE C0.ST$~ 1 ~ Personal Repreaenlative's Commissions Name of Personal Representative (s) Street Address Cdy State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemptbn: (If decedent's address is not the s ' 78827 ame as daimaM s, aMach explanation) 3r~p0 Claimant fCa Hartman Street Address 3801 Sullivan Street City Med7enicsburp State PA Zip 17350 Relationship of Claimant to Decedent 4. Probate Fees ister of WAb 300 5. Accountant's Fees 5. Tax Return Preparers Fees Robert RsiNy repair 84.8 7. T07AL (Also enter on line 9 Recapitulation) ~ 23765 9 more space Is needed. maert add@(onal sheets of the same sae) COMMONWEALTH OF PENNSIIVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT Nartman Can B SCHEDULEI DEBTS OF DECEDENT, 2'1.08.478 Record debb Incurred by the deeeWM plot W tlealh whkh remained unpaid p of Bx dale of ITEM deatlr, Mclude unroimburoed medkal expenase. NUMBER 1. NDrw DESCRIPTION AMOIre TOTAL (Abo ender on Gne 10, of the same sae) REV-1513 EX i (9-DD)) cOrnrnoNwEA~rR OF rENNSnvANw INNERRANCE TAI( RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY tramfera under Sec. 9116 (a) (1.2)] HaNnan 3601 SuWVarl Sf Mech~ligpurg PA Do Not List Tnrstee(s~ daughter 100 _.. _..,,,...-....~.wwwv la rut uU-IRBUf10NS SFIOIMJAB011E ON L1~FS 1571fiO00Fi 1& ASAPPROPPoAT~ ON RE16150DCOVQ2SFiEF! NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE cane B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS none TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV- 150DCOVER SPIFFY more apace