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Home My WebLink About04-0843 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of also known as , Deceased Social SecuriW No. 160-68-7957 (COMPLETE "A" OR "B" BELOW:) [~ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut named in the Last Will of the Decedent, dated and codicil(s) dated Except as follows, Decedent did not merry, 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: B. Grant of Letters of Administration 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: I Name Relationship Residence I k'RT.~TY~ A_ HA~TW~¥F~ ~4T~ 143 EWE RD., MECHANICSEURGt PA ~R~ N. HJ~RTI~YER DAUGHTER 143 ~ RD. t F,.E~H~ICSBURGf PA (COMPLETE IN ALL CASES:) Attach additional heels if necessary. ,~ , ~"~ C; Decedent was domiciled at death in CUMBERLAND County, Pennsylvania. with h er last familY or principal residence at 7].9 [-]ERNAN AVERSE, LEt4OYNE, PA [7043 : Decedent, then 30 . years of age. died 09-01 , 2004, at MAHANO¥ TWP., SCHUYLKILL CO., PA Decedent at death owned property with estimated values as follows: r~:~ !~, {If domiciled in PA} All personal property ................ ............. ~J~ 2-! 000.00 (If not domiciled in PA) Personal property in Pennsylvania ...................... $ (If not domiciled in PA) Personal property in County .......................... $ Value of real estate in Penns~vanie ............................................... $ Tota~ .............................................................. S 2,000.00 Real Estate situated es follows: Wherefore. Petitioner(s) respectfullv 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: Signature Typed or printed name and residence ] 143 EWE RD., MECHANICSBURG, PA Oath of Personal Representative Commonwealth of Pennsylvania County of__Cumberland The Petitioner(si above-named swear(s) and 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 and affirmed and subscribed before me this \ t'¥~ day of DECREE OF REGISTER Ed,ate of also known as Social Security No: ~!~l~-f~.~'- ANDNOW,~ )f~h , 20_~__,inconsidorationofthePetition on the reverse side hereon, satisfactory proc having been presented before me, IT iS DECREED that Letters I-I Testamentary ~of Administration are hereby granted to ~',B-~, in tho abova estate and that the instrument{s), if any, dated described in tbs Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $ ~. OL~ Short Certificate(s) .......... $ ldo .OO Renunciation .................. Affidavit ( ) ................. Extra Pages ( ) ............ Codicil .......................... JCP Fee ........................ $ I ~). ~ Attorney: Inventory & Tax Forms... $ I.D. No: Other ............................$ Address: TOTAL ................ $~ ~ ' ~ Telephone: DATE FILED: ~-7a 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 filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ P 10530727 CERTIFICATE OF DEATH (Coroner) I ~hanoy ~., 81, mile ~rker 132 A. Bowen ~Lemoyne, PA 17043 ~ ~. 719 Hermn Avenue, Lemoyne, PA 17043 ~ ~ ~ September 8, 2004 ,,~ Emanuel Cemetery . ,,~airview ~., PA 17339 ~. FD 012 848 L ~.O. Box 431 New PA 17070-0431 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: KENNETH K. HARTMOYER II Date of Death: 09/01/2004 Will No. 2004-00843 PA. No. 21-04-0843 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on 9/21/04 : Name Address Kristyn K. Hartmoyer, 143 Ewe Road, Mechanicsburg, PA. 17055 Kara N. Hartmoyer, % Kristyn K. Hartmoyer, 143 Ewe Road, Mechanicsburg, PA. 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except __ None Date: 9/21/04 ~_ ~~ ~gnature Name G. Patrick O'Connor, Esq. Address 3105 Old Gettysburg Road Camp Hill, PA 17011 ~ Telephone (717) 737-7760 ~' Capacity: Personal Representative X Counsel for Personal eq Representative IN T] tE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: FILE NO. 2004-00843 ESTATE KEN'NET K. HARTMOYER, II ESTATE PROBATE PRAECIPE FOR WITHDRAWAL OF APPEARANCE To: The Register of Wills of the Court of Common Pleas of £ umberland County, Pennsylvania Plea ~e mark the withdrawal of the undersigned as counsel for the administrator in the above c~ ~tioned matter, as requested by the administration in the attached letter. Thank you. , G. Patrick O'Connor, Esquire Attorney I.D. No. 64720 3501 Old Gettysburg Road Camp Hill, PA 17011 Phone: (717) 737-7760 Dated2~'?-- /' d' ~ October 27, 2004 G. Patrick, )'Cormor 3105 Old (ettysburg Road Camp Hill, PA 17011 Dear Mr. ( 'Connor: I'm son / haven t corresponded with you before this. Things are progressing fairly smoothly ~ ith settling my husband's estate, but it has been keeping me busy. I apprec ate the assistance you have given me during this difficult time in my life. However, v ith the way things are progressing, I do not foresee a need to continue to retain your ;ervices. I understand the previous $650.00 retainer that I initially gave you on Septeml: ~r 14, 2004, has been fully spent, and as far as I am aware I have not incurred any additim al expenses from your services. I would ~ .ppreciate it if you would send me my file and/or any official documents you may be hole ing on my behalf at your earliest convenience. Thank you again for the help you have gi ,en me. Sincerely, Kristyn A. Hartmoyer CERTIFICATE OF SERVICE I he 'eby certify that I have, this day, served the herein PRAECIPE FOR WITHDR WAL OF APPEARANCE to the Personal Representative indicated below by depositin~ ame in the United States mail, postage prepaid, at Camp Hill, Pennsylvania: Kristyn A. i tartmoyer 143 Ewe R~ ,ad Mechanics[ urg, PA 17055 .d~. Patrick O'Connor, Esquire Attorney No. 64720 3105 Old Gettysburg Road Camp Hill, PA 17011 (717) 737-7760 Counsel for Personal Representative . - . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA INRE: No. 2004-00843 ESTATE OF . . KENNETH K. HARTMOYER, II : ESTATE PROBATE PRAECIPE FOR ENTRY OF APPEARANCE TO THE REGISTER OF WILLS OF THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA: Please enter the appearance of the Law Offices of Duane P. Stone, P.C., and the undersigned on behalf of Kristyn A. Hartmoyer, administrator, for the Estate of Keneneth K. Hartmoyer, II in the above-captioned matter. Respectfully submitted, Law Offices of Duane P. Stone, P.C. Dated$(l,~ BYfE~~ Duane P. Stone, Esq. Attorney I.D. No. 85715 P. O. Box 696 Dillsburg, PA 17019 (717) 432-2089 jZZC>tJ)' J Attorney for Kristyn A. H~6er ~n ~'.J \)- CERnnCATEOFSER~CE The undersigned hereby certifies that on this date a true and correct 1---:) C'~ C:::J c..n '- ..0 -,:-~ copy of the foregoing PRAECIPE FOR ENTRY OF APPEARANCE was served by first-class United States mail, postage prepaid, upon the following: r:Y N G' ,,-'.', '~. c'\ . ~.,-1 CJ {rl o -n CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing PRAECIPE FOR ENTRY OF APPEARANCE was served by first-class United States mail, postage prepaid, upon the following: Kristyn A. Hartmoyer 143 Ewe Road Mechanicsburg, PA 17055 Dated: ~ /2 2ooS./ (J / ~9~-IJ(e0J Duane P. Stone, Esq. Attorney I.D. No. 85715 P. O. Box 696 Dillsburg, PA 17019 (717) 432-2089 Attorney for the Administrator COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: KENNETH K HARTMOYER II Deceased Court File No: 21040843 TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,_. Estates, and Fiduciaries Code, 20 PA.C.S.A. lj3532(b)(2). s.; DISCOVER FINANCIAL SERVICES, INC. .-. 2) CIO BALOGH BECKER LTD. 4150 OLSON MEMORIAL Claimant's address: HWY #200 MINNEAPOLIS, MN 55422 877-768-4465 Creditor listed below is the owner and holder of a claim in the amount of $ 3855.00 1) Claimant's name: -, -,.."., 3) f~) en \,!,) 4) The facts upon which this claim is ..based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: PA 6) Date of Death: 09/01/04 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, I do solemnly declare and affirm under the penalties of perjury that they Information and representations made ein are true and correct to the best of kno ~~formatior:...and belief. Dated: ZA---/ helsea Whitley/Angela Horn/Mary Ellen WeemanJChad BolinskelThersia LeeJKamille Dean, Atly-in-Fact Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: KRISTEN HARTMOYER Name 143 EWE RD Address MECHANICSBURG, PA 17050 City /State/ <' Date noti ::r IN RE ESTATE OF: KENNETH K HARTMOYER II AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of$3855.00 account number 6011002740650940 evidenced by 4. The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not :lD~ _ Attorneys-in-Fact: -~ Chelsea A. Whitley ~ Angela M. Horn_ Mary Ellen Weeman _ Thersia O. Lee_ Chad 1. Bolinske Kamille R. Dean 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 Subscribed and sworn before me This 027 day of ~, 2005. N ry Public . STEPHANIE A. JOHNSON . NOTARY PUBLIC - MINNESOTA , MY COMMISSION EXPIRES 1131/08 C. L~.: C) , c: '-;~.: t__) ~ C..=: LU f"-- .." n- C';, () LT', c:: . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 N f 0 d t Kenneth K. Hartmoyer, " ame 0 ece en : Date of Death: 09/01/2004 Estate No.: 2004-00843 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, 1 report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes [&I No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: N/A 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 18l No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: n/a C. Did the personal representative state an account informally to the parties in interest? Y es ~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk e Orp han~' Court a d may be o attached to this report. ../ (,V) &Jate: Ju1Y~14, 2006 ~~ /:.. ~ Signature .... _....l Duane P. Stone Name 8 N. Baltimore Street Dillsburg, PA 17019 Address ---;. -'., ~ ,""r:"> t:.:::::...... = c:-J (-- 717 -432-2089 Telephone No. Capacity: 0 Personal Representative Qg Counsel for personal representative / : ,- L_,/ _.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '*' Bure.au of Individual Taxes PO BOX 280601 Hamsburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 04 00843 Date of Birth 1130-68-7957 09/01/2004 08/24/1974 Decedent's Last Name Suffix Decedent's First Name MI Hartmoyer 11 Kenneth K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Hartmoyer Kristyn A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW .' 1 Onginal Return 2 Supplemental Return 3 Remainder Return (date of death prior to 12-13-82) 5 Federal Estate Tax Return ReqUired 4a Future Interest Compromise (date of death after 12-12-82) 7 Decedent Maintained a Living Trust (Attach Copy of Trust) 10 Spousal Poverty Credit (date of death 11. Election to tax under See 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4 limited Estate 6 Decedent Died Testate (Attach Copy of Will) 8 Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received Duane P Stone (717) 432-2089 Frm Name (If Applicable) L.aw Offices of Duane P First line of address PO Box 696 Second line of address ') w City or Post Office State ZIP Code DlIlsburg PA 17019 Correspondent's e-mail address Duane@StoneatLawcom Under penalties of perJury, I declare that I have examined this return, including accompanYing schedules and statements, and to the best of my knowledge and belief, It is true, correct and complete Declaration of preparer other than the personal representalive is based on all Information of which preparer has any knowledge DATE S!Jiiii!lI.F PERSON RES~L~ FOR FILING RETURN _ 1. m fltJ/t;, ~ d______ ADDRESS 143 Ewe Road Mechanlcsburg PA 17055 ~1~=R77X;5ENTATIVE .ADDRESS PO Box 696 Dillsburg, PA 17019 dress = 8 N Baltimore St, Dillsburg, PA 17019 PLEASE USE ORIGINAL FORM ONLY DATE Side 1 L_ 15056051058 15056051058 ~ _.J 15056052059 REV-1500 EX Decedent's Name Kenneth K Hartmoyer RECAPITULATION Real estate (Schedule A) 2 Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 4 Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 JOintly Owned Property (Schedule F) Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested. 8 Total Gross Assets (total Lines 1-7) 9 Funeral Expenses & Administrative Costs (Schedule H) 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 Total Deductions (total Lines 9 & 10). 12 Net Value of Estate (Line 8 minus Line 11) 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been made (Schedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec 9116 (a)(12) XO_ 000 16 Amount of Line 14 taxable at lineal rate XO _ 0.00 17 Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X 15 19 TAX DUE 10. 11 12 13 14. 15 16 17 18 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L_ Decedent's SOCial Security Number 160-68-7957 000 2 000 3 000 4. 000 5 4,559.23 6. 000 7. 000 8 4,559,23 9,91168 9 11,211.21 21,122.89 -16,563.66 000 0.00 000 000 19 0.00 15056052059 --.J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Kenneth K Hartmoyer ----~-------~-----~-- STREET ADDF<ESS 173 Herman Avenue ~---- ----~ ----- 21 04 00843 DECEDENT'S SOCIAL SECURITY NUMBER 160-68-7957 -- -- --I STATE I PA ---- I ZIP CITY Lemoyne Tax Payments and Credits: 1 Tax Due (Page 2 line 19) 2 Credlts/F'ayments A. Spousal Poverty Credit B Prior Payments C DlscoJnt (1) 000 Total Credits (A + B + C ) (2) 000 3 InterestlPenalty If applicable D. Interest E Penalty TotallnteresUPenalty ( D + E ) (3) 4 If line 2 is greater than line 1 + line 3, enter the difference This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 000 5 If Line 1 + Line 3 IS greater than line 2, enter the difference This is the TAX DUE. (5) B. Enter the total of Line 5 + 5A ThiS is the BALANCE DUE. (5A) (5B) A. Enter the Interest on the tax due. 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT IPLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and a retain the use or income of the property transferred; . b retain the right to designate who shall use the property transferred or its Income; c retain a reversionary interest; or d receive the promise for life of either payments, benefits or care? 2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiVing adequate consideration? 3 Old decedent own an "In trust for" or payable upon death bank account or security at his or her death? 4 Old decedent own an Individual Retirement Account, annUity, or other non-probate property which contains a beneficiary designation? Yes ........0 o ..0 o No ~ ~ [KJ ~ o o ~ ~ o ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 PS S9116 (a) (1.1) (i)] For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse IS zero (0) percent [72 PS S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000 The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 PS S9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 PS S9116(12) [72 PS s9116(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 PS s9116(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 REV-1502 EX+ i6-9S: SCHEDULE A REAL ESTATE COI'~MONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hartmoyer Kenneth K II 2004- i.: 00843 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value IS defined as the price at which property would be exchanged between a Willing buyer and a Willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts Real property which is jointly -owned with right of survivorship must be disclosed on Schedule F ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH None 000 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 0.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE T/\X RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Hartmoyer, Kenneth K II 2004 - FILE NUMBER ~ 00843 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITcM NUMBER I DESCRIPTION VALUE AT DAT[ OF DEATH None 000 TOTAL (Also enter on line 2, Recapitulation) $ 000 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSElY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP tm_ RI::\I-15()4 tcX+ (6-9S: \" et ,'I 1;' '~ ESTATE OF Hartrnoyer, Kenneth K II FILE NUMBER 2004 - 00843 ITEM r,UMBER NUMBER Schedule C-1 or C-2 (including all supporting Information) must be attached for each closely-held corporation/partnership Interest of the decedent, other than a sole-proprietorship See Instructions for the supporting information to be submitted for sole-proprietorships DESCRIPTION VALUE AT DATE OF DEATH None 0,00 TOTAL (Also enter on line 3, Recapitulation) $ 0,00 (If more space is needed, insert additional sheets of the same size) RE:V-15J7 E:X+ (6-98) ~- -.Q ~ SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERIT,~NCE TAX RETURN RESIDENT DECEDl':NT ',-: < FILE NUMBER 2004 - 00843 ESTATE OF Hartrnoyer, Kenneth K II ITEM NUM3f=:R All property jointly-owned with right of survivorship must be disclosed on Schedule F DEseRI PTION VALUE AT DATE OF DEATH None 0,00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 000 RtV 150:3 EX+ 16-9H) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hartmoyer, Kenneth K. II 2004 - , FILE NUMBER 00843 -u ITEM NUMBFR Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with right of survivon;hip must be disclosed on Schedule F VALUE AT DATE OF DEATH DESCRiPTION Personal Property and Separate Bank Account liquidated then placed In Estate Account with Members 4,55923 ~ FeU Acct # 251035 ISi TOTAL (Also enter on line 5, Recapitulation) $ (if more space is needed, Insert additional sheets of the same size) 4,55923 REV,1509 EX+ 16-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE lAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER 00843 Hartmoyer, Kenneth K II 2004- 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 B c JOINTIXOWNED PROPERTY: ITEll NUM~,~ - -~-_. LEHER DATE DESCRIPTION OF PROPERTY OF DATE OF DE,',"H FOR JOI~T MADE INCLUDE NAME OF FIN.',NCIAL INsmUTICN ,"ND BANK ACCOUNT NUMBER OR SIMILAR D,A-E OF DEATH DeeD'S Vt..LUE OF R TENAIH -- JOINT IOElrlf\'ING MIMBER, "HAeH DEED FOR JOINTLY-HELD REAL ES-ATE V,"LUE Of ASSET IIrERES- CfCEDENTS INTEREST A None TOTAL (Also enter on line 6, Recapitulation) $ 0,00 (If more space is needed, Insert additional sheets of the same size) REV 15'iO EX+ (6-98: .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISe. NON-PROBATE PROPERTY FILE NUMBER ESTATE OF Hartmoyer, Kenneth K II 2004 - 00843 This schedule must be completed and filed If the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET IS yes DESCRIPTION OF PROPERTY INC'cUDE THE NAME Dr THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECDS EXCLUSION TAXABLE EI~ THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST Ilf APPLICABLE) VALUE None 000 000 TOT AL (Also enter on line 7 Recapitulation) $ 0,00 ITEM NUMB (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Hartmoyer, Kenneth K II FILE NUMBER 2004 - 00843 Debts of decedent must be reported on Schedule I. ITEM NUMElER A DESCRI PTION AMOUNT FUNERAL EXPENSES Traditional Funeral Service 6 Clergy 4,95900 2,81000 98900 196.68 5400 125.00 2 3 Oak Casket 12 Gauge Steel Vault Death Notice and Certified Caples Transportation 4 5 B ADMINISTRATIVE COSTS Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State ZiP Year(s) Commission Paid 2. Attorney Fees 650.00 :3 Family Exemption (If decedent's address IS not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4 Probate Fees 128 00 5 Accountant's Fees 6 Tax Return Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) $ 9,911.68 (If more space is needed, insert additional sheets of the same size) REV1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hartrnoyer, Kenneth K II FILE NUMBER 2004 - - ,00843 ITEM NUM3ER "- Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses DESCRIPTION VALUE AT DATE OF DEATH Discovery FinanCial Services 3,855.73 2 Visa 2,14591 :3 Omnium Worldwide, Inc 5,209S1 TOTAL (Also enter on line 10, Recapitulation) $ 11,211.21 (If more space is needed, insert additional sheets of the same size) RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABL E DISTRiBUTIONS [include outfight spousal dlstnbutions, and transfers under Sec. 9116 (a) (12)] Kristyn A Hartmoyer Spouse 100'Yo Kara N. Hartmoyer Daughter 0% Estate account opened to facilitate guardianship for receipt of life Insurance funds for Minor, and to deal with debt ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON- TAXABLE DISTRIBUTiONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE ~Herman Avenue, Lemoyne, PA 17043 - Joint Tenancy by Entireties (Purchased May 1, 1996~ 100% ( No other appropriate schedule from instructions to place home. Copy of deed attached) B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ RE'V51:1 EX+ (9-rV:) \'" I y' ~ COMMONWE.4LTH OF P::NNS"L'!ANIA IlmERITANCE TAX RHURI; RESIO::N: DEeEDEr,T ESTATE OF Hartmoyer, Kenneth K. II NUMB I 2 3 II SCHEDULE J BENEFICIARIES (If more space is needed, insert additional sheets of the same size) FILE NUMBER 2004 - 00843 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA PEPARTMENT OF REVENUE OFFICE (":-NOTICE OF INHERITANCE TAX '=: ,~. -A1Pl'R,A!SEHENT, ALLOWANCE OR DISALLOWANCE OF' DEDUCTIONS AND ASSESSHENT OF TAX 08-28-2006 HARTMOYER II 09-01-2004 21 04-0843 CUMBERLAND 101 APPEAL DATE: 10-27-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS +- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HARTMOYER II KENNETH K FILE NO. 21 04-0843 ACN 101 I~ an asses...nt was issued previously, lines 14, 15 and/or 16, 17, 18 and reflect ~igures that include the total ~ ~ returns assessed to date. ASSESSMENT OF TAX: IS. AIIow\t of Une 14 at Spousal rate liS) 16. AIIow\t of Line 14 taxable at Lineal/Class A rate (16) 17. AIIoWlt of Une 14 at Sibling rate (17) 18. ABount of Line 14 taxable at Collataral/Class B rata (18) 19. Principel Tax Due 2006 i~lUG 28 Pi'l 12: 05 OHi' '-'1 I! ' DUANE P STONE v DUANE P STONE LAW OFCS PO BOX 696 DILLSBURG PA 17019 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgagas/Notes Racaivable (Schedule D) S. Cash/BankDaposits/Hisc. Personel Property (Schedule E) 6. JOintly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Ada. Costs/Hisc. Expanses (Schedule H) 11. Dabts/Hortgaga Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Retum 13. Charitable/GovernB8ntal 8aquasts; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax NOTE: DATE IiUl8ER INTEREST/PEN PAID (-) · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ( ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 4.559.23 .00 .00 (8) I *' REV-1547 EX AFP (06-05) KENNETH K (9) llo) 9,911.68 DATE 08-28-2006 NOTE: To insure proper credit to your account, subIIi t the upper portion of this fora with your tax paYll8l\t. 4.1559.23 :11 .1:1:1 89 16.1563.66- .00 16,563.66- 19 will 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 11 .211 21 (11) (12) (13) (14) (19)= .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) (Schedule oJ) .00 X .00 X .00 X .00 X AtIOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE