HomeMy WebLinkAbout04-1146Register of Wills of Cumberland
PETITION FOR GRANT OF
Estate of Lawrence M. Garman
also known as
Rex A. Carman and Richard M. Carman
County, Pennsylvania
LETTERS
, Deceased Social Security No. 722 - 16 - 0091
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 ors
the Decedent, dated 08/22/2001 and codicil(s) dated None
N/A
named in the last Will of
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 (~l?3the docume~
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 absenti~.;.~n{'-~c
Petitioner(s) after a proper search has/have ascertained that Decedent left no W~II and was survived by the following Sl:~use (~f any)
heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at
Decedent, then 77 years of age, died
18 Chestnut Street, Lower Allen Township, Camp Hill, PA 17011
(liststreet, number, and municipally)
12/02/2004 at Harrisbur~ Hospital, Harrisburs, PA, PA
(Location)
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
$ 9,500.00
$
$
$ 120,000.00
situated as follows: 18 Chestnut Street, Camp Hill, Cumberland County, Pennsylvania
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:
Typed or printed name and residence
Rex A. Carman
1834 Anna Street, New Cumberland, PA 17070
Richard M. Carman
208 Willow Mill Park Road, Mechanicsburs, PA 17050
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-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 t~/~est~t~,~acc~ing to law.
Sworn to or affirmed and subscribed
~ Rf~ A. Carman ~~~ ~__
_~./~ , jl~ ~ff Richard M. Carman
' ' For the Register ,v ! v
No,
Estate of Lawrence M. Garman Deceased
Social Security No: 722-16-0091 Date of Death: 12/02/2004
A.D .ow,
/-~g~ 4~/'i in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary [~ Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Rex A. Carman and Richard M. Carman
in the above estate and that the instrument(s) dated 08/22/2001
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s) ..... $
Renunciation ........ $
Attorney: James D. Bo~ar, Esquire
Affidavits ( ) .... $
Extra Pages ( '~ ) .... $
I.D. No: 19475
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737~8761
Codicil ........... $
JCP Fee .......... $ / 0. ~
Inventory .......... $
Other ........... $
TO A, .........
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Register of Wills of Cumberland
OATH OF SUBSCRIBING
Estate of Lawrence M. Carman
also known as
County, Pennsylvania
WITNESS
, Deceased
3ames D. Bosar Bonnie L. Williams
(each) a subscribing witness to the r'-'] codicil(s) r~ will(s) presented herewith, (each) being duly qualified according to law
depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as
a witness at the request of Testator(rix) in his/her/their presence and r~ in the presence of each other [] in the presence of the
other subscribi[~witness(es).
dames~/D .{ Bo§ar
One W~ Main Street
Shiremansto- wn, PA 17011
(Address)
(Signature) Bonnie L. Williams
One West Main Street
Shiremanstown, PA 17011
(Address)
Sworn to or affirmed and subscribed
before me this / ~.~ ~ j~ day
My Com~hission Expires:
(Si~naturo and ~eal of ~o~a~ or other official
qualified to adm~ni~tor oaths. Show da~e of
expiration of ~ota~'s commi~ion.)
COMMONWEALTH OF PENNSYLVANIA
l Notarial Seal I
Jennifer B. Hipp, Notary Public
Shiremanstown Boro, Cum~rlan. d C~gu~gtY
My Commission Expires Oct. 1, 2uu,
Member, Pennsylvania Association of Notaries
NOTE:
To be taken by officer authorized to administer oaths.
Please have present the original or copy of instrument(s)
at time of notarization.
Prepared by the Pennsylvania Bar Associat{on
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-2 (1991)
RENUNCIATION
In Re Estate of Ixawrence M. c'~rman
deceased.
To the Register of Wills of.
~land
County, Pennsylvania.
The undersigned Sally A. Steiner, clau~hter of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
be issued to R~x A. Garman and Richard M. c'~nnc~n
WITNESS
hand this 7th day of Deeenlaex: ., ~2004 .
~7 ~leX'(Sig~ature)
227 CO4~r Springs Place
~is~, ~ 35758
(Address)
(Signature)
(Address)
(Signature)
(Address)
l'ifi>. 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, $2.00
P 10688924
No.
Local ReglsU ar
H105 143 Rev 2/87
NAME OF DECEDENT (First, Middle, Last)
,. Lawrence M.
AGE (Last Buthday)
7 7 Y"
COUNTY OF DEATH
)auphin
DECEDENT'S USUAL OCCUPATION
,~.. Teacher Education
18 Chestnut Street 'ACTUAL
~o. Shireman~own, pA 17011
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FiLE NUMeER
SEX J SOCIAL SECURITY NUMBER DATjE (~F DEATH (Month, Day. Year)
DATE OF BIRTH BIRTHP~CE (City aM IP~CE OF ~ATH (C~ o~v ~e - s~ insl~lj~} qn 9~h~( ~j} '
~M~, O~, ~ear) S~ ~ F~agn Co~t~)j HO~T~: /OTHER:
oune z~, i~arrisburg,PA [ ....... m ~u--,~, m ~,O
ttarrisburg [..Harrisburg ~ospital [ ~ex~n. P~ Rican. etc ,0. white
J US ARMED FORCES? (~ea~ on~ ~esl ~.~ co~e~d) Never Maffied, ~dow~, (, w,le, g,ve maiden nan,et
a~. 10,~} 6 (,-4 ~ ~.) ,4. widowed
17b. County Cumberland t~.s.~p? ~zd.~ NO.
FATHER'S NAME (First, Middle, Last)
18. Lawrence W. Garman
INFORMANT'S NAME (Type/Pri~/)
~oa. Rex A. Garman
METHO~ OF DISPOSmON I OATE OF D, SPOS,T,ON
2,,. o,~(sp~> ~ 2~b. December 3, 2004
SIGNATUR~~RV;C5 UCENS~ OR PERSON ACTING AS SUCH tIC, NS5 NURSER
22.. ~~~~ 22b. FD 012 848
I
I~ 24-~ ~*I b~ ~m~l~d b~ ~ TI~ OF DEAT~ ~ ~ DA~.~ROMOUNCED. O~AO {M0nlh, Da~. Y~a0 ~ WAS CASE REFERRED TO A M~DICA~ E~MINER ICORON~R9
MOTHER'S NAME (First, Middle, Maiden Surname)
fL Pearl g. Conrad
INFORMANT'S MAILING ADDRESS (Street, Cdy~own, State, Zip Code)
~. 1834 Anna Street, New Cumherland~PA 17070
.... ,C .... ..... ILOCAT,ON-C,,y,, .o. Sta,e. ,pCode
J2,~. Yorkto~me Crematory I~,~. York, pA 17404
NAMEANDADORE$SOFFACILffYParthemore FH & CS, Inc.
L =z~.P.O. Box 431~ New Cumberland~ PA 17070-0431
Approxkna e
interval belweet
onset and death:
PART I1: Other sign~Canl conditions contributing Io death, but
not resulting in the underlying cause given in PART I
WAS AN AUTOPSY I W~RE AUTOPSY FINDINGS I MANNER OF DEATH I DATE OF INJURY I TIME OF INJURYI INJURY AT V~)RK? I DESCRIBE HOW INJURY OCCURRED
PERFORMED? AVAILABLE PRIOR TO ~; I (Month, Day. Year)
yes D No~l Y,, ~ No~ I Suiade D Could not od ~.,~minod ~1 30,. 13ob. ~. [ 3~. 30¢
~ I ~ ~ I ~ I PLACE OF INJURY At home. farm, street, factor, o~ LOCATION (Street Cily~own, State)
CERTIFIER (Check only ~e) --/S~~ ~.
'CER~FYING PHYSICIAN (Physicla~ ~Rify ~ cau~ of ~th w~n another physician has ~on~d death and ~m~eted item 23) ~ ~
To the best o,my knowledge, de,th occflr~d due 1o ~ ....... (s) and ~ ........ t,ted ............................................................... ~b.~--
LICENS~UMBER ~ DAT[S GNED (M~ h. Day.~.~
'PRONOUNCINGTo the best of AND CERTIFYING PHYSIC~N (PhysiQan ~ prono~ci~ deat~ a~ ~l~i~ to cause of ~ath) ~ -~ ~. ~ . , . ~ ~ ~ t T · I ~ ~ ~ '
~ME ANO ADORESS ~ PERSON ~OMeLETED CAUSE OF DEATH
"MEDICAL EXAMINE~CORONER (tem 27) Type ~ P~t { ) ~ ~ LC[ [
On the basis of examl~aUon andlorlnvestlgaflon, In my opinion, death ~curred at the tl~,date, and place, and due to the caused(i) a~d --.q ~ -- t' ~ ~ ~-~ x~-
~'-/I~1/K J' OATE FILED (M~lh. Day, Year,
34. ~ _& ~ ~
I,AST WILL AND TESTAMENT
OF
~WRENCE ]4. G~RI~ ~
I, LAWRENCE M. GARMAN, of Camp Hill, Cumberlan~
Pennsylvania, make, publish and declare this as and for m¥c
Will and Testament, hereby revoking all other Wills and ~
heretofore made by me. ~
FIRST: I devise and bequeath all the rest, residue a~
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, in equal shares, to
my children, REX A. GARMAN, RICHARD M. GARMAN, and SALLY A.
STEINER, provided that should any of my children predecease me, I
give and bequeath such child's share unto his or her issue per
stirpes by representation, and if there be a failure of same,
then I give and bequeath such deceased child's share to my
surviving children as provided herein.
SECOND: Should any of my grandchildren not have
attained the age of twenty-three (23) years at the time for
distribution to him or her, I give, devise and bequeath the share
of each such grandchild to my hereinafter named Trustee or
Trustees, IN SEPARATE TRUSTS, to hold, manage, invest and
reinvest the shares so received, and to use and apply from time
to time such portion of income and principal for the said grand-
child's post-high school education (including college, trade
school or other similar training or education), as my Trustee or
Trustees, in their sole discretion, deem advisable. The Trustee
or Trustees, in exercising their discretionary authority with
respect to the payment of income or principal of the within Trust
to my grandchildren, shall take into consideration any income or
other resources available to my grandchildren from sources
outside this Trust.
Any income or principal not so applied shall be dis-
tributed to each grandchild when he or she attains the age of
twenty-three (23) years. In the event any of my grandchildren
die prior to the termination of the Trust established herein for
their benefit, the interest of my grandchild in said Trust shall
cease with any income and principal being divided evenly between
or among that deceased grandchild's brothers and sisters or the
separate trusts established hereunder for their benefit and, in
the absence of any brothers and sisters, to my other grandchil-
dren in equal shares.
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FOURTH: I nominate and appoint REX A. GARMAN, as
Trustee of the hereinabove described trusts. In the event of the
death, resignation or inability to serve for any reason whatso-
ever of the said REX A. GARMAN, I nominate and appoint, RICHARD
M. GARMAN, as Trustee of the hereinabove described trusts. In
the further event of the death, resignation or inability to serve
for any reason whatsoever of the said REX A. GARMAN and RICHARD
M. GARMAN, I nominate and appoint, SALLY A. STEINER, as Trustee
of the hereinabove described trusts. I direct that my Trustee or
Trustees shall serve without bond and shall receive fair and
reasonable compensation.
FIF?H: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
BIXTH: I nominate and appoint REX A. GARMAN, RICHARD
M. GARMAN and SALLY A. STEINER, Co-Executors of this, my Last
Will and Testament. I direct that my Co-Executors, Trustee or
Trustees, as the case may be, and their successors, shall not be
required to post security or a bond for the performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this ~day of
.~ ~ , 2001.
WRENCE M. GA~MA~
Signed, sealed, published and declared by the above-
named Testator as and for his Last Will and Testament in our
presence, who, at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address ~ -'-~ ~/~
Address
4
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Lawrence M. Garman
Date of Death: December 2, 2004
will No. 21-04-1146 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 beneficiaries of the above-captioned estate on
December 15, 2004:
Name Address
Rex A. Garman
Richard M. Garman
Sally A. Steiner
1834 Anna Street
New Cumberland, PA
208 Willow Mill Park Road
Mechanicsburg, PA 17050
227 Cedar Springs Place
Madison, AL 35758
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
Date:
Capacity:
Ja~es D. B~r, Esquire
One West M~ Street
Shiremanstow~, PA 17011
(717) 737-8761
Personal Representative
X Counsel for Personal
Representative
JAMES D. BOGAR
ATTORNEY AT LAW
ONE WEST MAIN STREET
SHIREMANSTOWN. PENNSYLVANIA 1701 I
e-mail mail@bogarlaw.com
TELEPHONE
[7 I 7) 737-8761
FACSIMILE
(717) 737-2086
JAMES D. BOGAR
JENNIFER B. HIPp.
.Also admitted to New Jersey Bar
Direct e-maIlJbogar@bogarlaw.com
March 1, 2005
VIA HAND DELIVERY
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
f<:'
RE:
(,t;
( "
The Estate of Lawrence M. Garman
No. 21-04-1146
Date of Death: December 2, 2004
Dear Ms. Strasbaugh:
I represent the Estate of Lawrence M. Garman. Enclosed is a
check made payable to the Register of Wills in the amount of
$8,550.00, same constituting a prepayment at discount on account
of pennsylvania inheritance taxes in the above-captioned estate.
The prepayment is determined as follows: $200,000.00 multiplied
by 4.5% or $9,000.00, less discount in the amount of 5% or
$450.00, resulting in payment of $8,550.00. Please provide me
with the appropriate receipt in this matter.
Your time and consideration in this matter is greatly
appreciated.
Very truly yours,
{~Dbzt
JDB/blw
Enclosure
cc: Rex A. Garman, Co-Executor (w/o encl.)
Richard M. Garman, Co-Executor (w/o encl.)
Sally A. Steiner (w/o encl.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BOGAR JAMES D
1 W MAIN STREET
SHIREMANSTOWN, PA 17011
nnnn told
EST A TE INFORMATION: SSN: 722-16-0091
FILE NUMBER: 2104-1146
DECEDENT NAME: GARMAN lAWRENCE M
DATE OF PAYMENT: 03/02/2005
POSTMARK DATE: 03/02/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/02/2004
NO. CD 005009
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $8,550.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#1269
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$8,550.00
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005636
GARMAN REX A
1834 ANNA STREET
NEW CUMBERLAND, PA 17070
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
~------- fold
101
$50,000.00
ESTATE INFORMATION: SSN: 722-16-0091
FILE NUMBER: 2104-1146
DECEDENT NAME: GARMAN lAWRENCE M
DATE OF PAYMENT: 07/29/2005
POSTMARK DATE: 07/29/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/02/2004
TOTAL AMOUNT PAID:
$50,000.00
REMARKS:
CHECK# 1003
SEAL
INITIALS: CCP
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV~1162 EXll1~96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005637
GARMAN REX A
1834 ANNA STREET
NEW CUMBERLAND, PA 17070
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
____n~~ fold
101
$562.84
ESTATE INFORMATION: SSN: 722~ 1 6~009 1
FILE NUMBER: 2104-1146
DECEDENT NAME: GARMAN lA WRENCE M
DATE OF PAYMENT: 07/29/2005
POSTMARK DATE: 07/29/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/02/2004
TOTAL AMOUNT PAID:
$562.84
REMARKS:
CHECK# 1002
SEAL
INITIALS: CCP
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Register of Wills of
Cumberland
County, Pennsylvania
INVENTORY
Estate of
Lawrence M. Garman
No.
21-04-1146
, Deceased
Date of Death 12/02/2004
Social Security No. 722-16-0091
also known as
Rex A. Garman
Richard M. Garman
The Personal Representatlve(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
Include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. lIWe verify that the statements made in this Inventory
are true and correct. lIWe understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
I.D.No.:
19475
Signature:
Attomey:
James D. Bogar
Signature:
Signature:
Firm: BOClar & Hipp Law Offices
Address: One West Main Street
Shlremanstown, PA 17011
Telephone: 717-737-8761
Address: 1834 Anna St.
New Cumberland, PA 17070
Telephone: 717-737-8761
Dated:
il;),') Jc 5
Personal Propertv
Cash...............................................................................................
Miscellaneous Property................................................................
Stocks/Listed.................................................................................
Stocks/Closely Held.............................. ................................ ........
Bonds..... ........... ............... ......................... .....................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
14,629.96
14,908.75
47,9n.17
Total Personal Property.........................................
77,515.88
Total Real Property................................................
139,900.00
Total Personal and Real Property.........................
217,415.881
Total Out-of-State Real Property..........................
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX lB0601
HARRISBURG PA 171Z8-0601
NOTICE OF INHERITANCE TAX
Rr..,~ ~...,.. '. Illlfl(; (AC. ,LOIIANCE OR DISALLOIIANCE
':.~;1i~~ .T~tlNs';AND ASSESSI1ENT OF TAX ON
~,c: ')I .::'. fLY'.itELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
REX A GARMAN
1834 ANNA ST
NEW CUMBERLAND PA 17070
CLER~< cr
Cr"'t'i] '.', """'1 I-IT
'i\~T;' :.. I:
0! p,'-'
\....'u,
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
08-01-2005
GARMAN
12-02-2004
21 04-1146
CUMBERLAND
722-16-0091
05110722
APPEAL DATE: 09-30-2005
(See reverse side under Objections)
AIIIaunt R8IIIi tted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
LAWRENCE M
Z005 i'UG - I PH 12: 27
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -
REY=is4S-EX-AFP-lo3=Osi--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-01-2005
ESTATE OF GARMAN
LAWRENCE M DATE OF DEATH 12-02-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1146
TAX RETURN WAS:
S.S/D.C. NO. 722-16-0091
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05110722
FINANCIAL INSTITUTION: SUSQUEHANNA VLY FCU
ACCOUNT NO.
47-00
TYPE OF ACCOUNT: ~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
DATE ESTABLISHED 05-10-2003
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
13,467.30
0.500
6,733.65
.00
6,733.65
.45
303.01
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
PAYMENT MUST BE MADE BY 09-03-2005*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 303.01
INTEREST AND PEN. .00
TOTAL DUE 303.01
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU NAY BE DUE A REFUND.
~~~ R~UFR~F ~YnE OF THIS FORM FOR INSTRUCTIONS. )
LAW OFFICES
HOWARDB KRUG
LEON P HALLER
JOHN W. PURCELL JR.
JILL M. WINEKA
BRIAN 1. TYLER
NICHOLE M. STALEY O'GORMAN
LISA A RYNARD
q>~J~rJ~
1719 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA J 7102-2392
TELEPHONE(7J7)234-4178
FAX (717) 234-0409
JOSEPH NISSLEY (1910-1982)
HERSHEY
(717) 533-3836
JOHN W. PURCELL
OF COUNSEL
August 26, 2005
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Victoria Hackenberger
Dear Sir/Madam:
Enclosed please find the original and three copies of the
Pennsylvania Inheritance Tax Return for filing with your office.
Please time-stamp the additional copies and return same to me in
the enclosed self addressed, stamped envelope.
Also enclosed is a check in the amount of $20.00 for the
filing fee.
Thank you.
Sincerely yours,
,tl~ejt I (1fi-/
Howard B. Krug
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HBK/ase
Enclosure
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REV-1500 EX. (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FilE NUMBER
2 1 -0 4 1 1 9 6
"'COuNnCOi5E -VEAR- - - NUMBER--
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HACKENBERGER VICTORIA V.
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURIT'Y NUMBER
DATE OF BIRTH (MM-DD-Year)
5 07- 1 8 - 3 3 1 6
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
12/01/2004 07/12/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURIT'Y NUMBER
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[Xl 1. Original Return
o 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AttachcopyofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST.BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX-INFORMATION SHOULD.BEDIRECTED TO:
NAME COMPLETE MAILING ADDRESS
HOWARD B. KRUG ESQUIRE 1719 NORTH FRONT STREET
FIRM NAME (If Applicable)
PURCELL KRUG & HALLER
TELEPHONE NUMBER
717-234-4178 HARRISBURG PA 17102
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec9113 Trusts for which an election to tax has not been
made (Schedule J)
OFFICIAL USE ONLY
';
......:.=::,
375,563.00.
0.00
. ,
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(8)
375,563.00
31,411.39
148,031.52
(11)
(12)
(13)
179,442.91
196,120.09
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
196,120.09
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
X _(15)
196,120.09 X .045 (16)
X .12 (17)
X .15 (18)
(19)
8,825.40
8,825.40
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlOE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
308 3RD STREET
CITY I STATE I ZIP
SUMMERDALE PA 17093
Tax Payments and Credits:
1, Tax Due (Page 1 Line 19)
2, Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C, Discount
(1)
8,825.40
9.520.00
441.27
Total Credits (A + B + C)
(2)
9,961.27
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If 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)
5, If 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 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,135.87
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 [Z]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Z]
c. retain a reversionary interest; or ...................................................................................................... 0 [Z]
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [Z]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 [Z]
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 [Z]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 [Z]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~..~
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NTATIVE
PA 17093
DATE
ADDRESS
PA 17102
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 3%
[72 P.S. 99116 (a) (1.1) (i)J.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of I
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory " ~ (~ ? b
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 yec
or a stepparent of the child is 0% [72 P.S, 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's line
Juse is 0% [72 P.S. 99116 (a) (1.1) (ii)J.
ng a tax return are still applicable even if
ie of a natural parent, an adoptive parent,
The tax rate imposed on the net value of transfers to or for the use of the decedent's sibl
Individual who has at least one parent in common with the decedent, whether by blood 0, "'^'fJlIVlI.
3~ ~\./\51'
'2 P.$, 99116(1.2) [72 P.S, 99116(a)(1)).
~ is defined, under Section 9102, as an
LAST WILL AND TESTAMENT OF
VICTORIA V. HACKEHBERGER
I,
County,
memory
declare
victoria V. Hackenberger, of Rye Township,
Pennsylvania, being of sound and disposing
and understanding, do hereby make, publish
this as my Last Will and Testament as follows:
Perry
mind,
and
1. I direct my hereinafter named Executor to pay
my just debts, funeral expenses and costs of administration
of my estate as soon as possible and convenient after my
death.
2 . I direct my hereafter named Executor to pay
out of the corpus of my estate, all state inheritance taxes
and federal estate taxes, if any be due, which may be
assessed by reason of my death on property passing under
this my Last will and Testament, or on property passing to
any person or persons by reason of joint ownership thereof,
such as certificates of deposit, savings bonds, etc. to the
intent and effect that no person shall be required to
personally pay any Pennsylvania inheritance tax or federal
tax thereon.
3. I give, devise and bequeath all the rest,
residue and remainder of my property, both personal and
real, of whatever nature and wheresoever situate, to my
husband, Leo Hackenberger, provided he survives me by thirty
(30) days.
4 . In the event my husband, Leo Hackenberger,
should predecease me or die on or before the thirtieth
(30th) day following my death, I give, devise and bequeath
all the rest, residue, and remainder of my estate, both
personal and real, of whatever nature and wheresoever
situate as follows:
KA THY A. MORROW
Attorney at Law
117 S. Carlisle Street
P.O. Box 250
, Bloomfield, PA 1706B
A. I direct that my children be given a
period of six (6) weeks in which to divide among themselves
my personal belongings including but not limited to
furniture, household furnishings, and tools, as equally as
possible. In the event that they are unable to arrive at a
satiSfactory division of these items, then I direct that my
Executor named hereafter dispose of said items at either
private or public sale and that the proceeds thereof be
divided equally among my three sons, Daniel L. Hackenberger,
~-U ~Vy.-e~/L
~ Richard R. Hackenberger, and william C. Hackenberger.
B. I direct that my Executor named hereafter
liquidate the remainder of my estate, whether real or
personal and wheresoever the same may be situate, and divide
the proceeds of said liquidation equally among my three
sons, Daniel L. Hackenberger, Richard R. Hackenberger and
William C. Hackenberger.
5. I hereby nominate and appoint my husband, Leo
Hackenberger, as Executor of this my Last Will and
Testament. Should my husband, Leo Hackenberger, fail to
qualify or renounces his right to act as Executor, I then
nominate and appoint my son, Daniel L. Hackenberger as
successor Executor of this my Last will and Testament.
6. I direct that my Executor or his successor
shall not be required to give bond or other security in any
jurisdiction wherein proceedings may be held in connection
with my estate. Nor shall any guardian of property or
persons be required to give bond for the faithful
performance of their duties in any jurisdiction.
seal
IN WITNESS WHEREOF, I hereunto set. my hand and
this c:;kS d.... day o~~ 1998.
~rj;.~?; /lo~~
v
( SEAL)
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Witness
KATHY A. MORROW
Attorney at Law
217 S. Carlisle Street
P.O. Box 250
lew Bloomfield, PA 1706B
i
COMMONWEALTH OF PENNSYLVANIA *
* ss:
COUNTY OF PERRY *
We, victoria V. Hackenberger, the testatrix in, and
k~17-f'1 A. /Y)of.eow and ).....,,.{1/1, Titr/1'~ , the witnesses
to the attached or foregoing instrument, who have signed the
instrument, having been duly qualified according to law do
depose and say:
(a) that I, the testatrix, do hereby acknowledge that
I signed and executed the instrument as my last Will, that I
signed it willingly and as my free and voluntary act for the
purposes therein expressed; and
(b) that we, the witnesses, were present and saw the
testatrix sign and execute the instrument as her last will,
that she willingly signed and executed it as her free and
voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the testatrix signed the
will as a witness and that to the best of our knowledge the
testatrix was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
~~~V~Y~h~~
~~ (j. 'Jh.~
;,~~-'ndQ ~~L~__
Witness
~bt
My commissi
KATHY A. MORROW
Attorney at law
217 S. Carlisle Street
P.O. Box 250
New Bloomfield, PA 17068
, ~'~;~2i~~~~~~~;~!:F;~",
.__..._--....._-~-,. .-
. REV-15m! EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HACKENBERGER VICTORIA V. 21 04 1196
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
11.
12.
13.
DESCRIPTION
VALUE AT DATE
OF DEATH
14,853.13
1 st National Bank Checking Account
#41-474-3 ($14,850 + $2.20 accrued interest)
(Copy of date of death statement attached.)
PSECU S01 Regular Shares savings account
#8503679352
(Copy of date of death statement attached.)
PSECU S04 Checking account
#8503679352
(Copy of date of death statement attached.)
MML Investor Services, Inc.
#HTM-007951
(Copy of date of death statement attached.)
Diamond Rings
Item #1 - Engagement Ring $135; Item #2 - Anniversary Ring $170
(Copy of appraisal attached.)
Coins (Grandchildren)
M - $.36; P - $.36; J - $.36; R - $.36
60,036.99
10,002.05
281,353.03
305.00
1.44
Miscellaneous coins
49.90
Value of Cemetery Plot
90.00
Attorney refund for 1/2 hour of fees due to incorrect billing
62.50
Highmark Insurance refund
299.00
Payment of debt (Mary Klinger)
50.00
Irrevocable Burial Trust
Shalonis Funeral Home
(See attached billing of Shalonis Funeral home.)
8,459.96
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
375.563.00
17053-0017
DUNCAN NON OFFICE:
55 South Main Street
Phone: (717) 834-5161
Fax: (717) 834-5639
MAIN OFFICE:
101 Lincoln Street
Phone: (717) 957-2196
Fax: (717) 957-4578
RIDGEVIEW OFFICE:
500 S. State Road
Phone: (717) 957-2114
Fax: (717) 957-4678
JANUARY 27, 2005
PURCELL KRUG & HALLER
1719 NORTH FRONT ST
HARRISBURG PA 17102-2392
RE: ESTATE OF VICTORIA V HACKENBERGER
HERE IS THE INFORMATION YOU REQUESTED PER YOUR LETTER OF 1-24-05:
CERTIFICATE OF DEP 3062489
VICTORIA V HACKENBERGER &
SHALONIS FUNERAL HOME
OPEN: 12-27-02
(NT RATE: 3.80%
DOD BAL: $6,140.49
DODINT: 100.37
CLOSED 12-7-04
CERTIFICATE OF DEP 3063814
VICTORIA V HACKENBERGER &
SHALONIS FUNERAL HOME
OPEN: 10-1-04
INT RATE: 3.55%
000 BAL: $2,200.00
DODINT: 12.41
CLOSED 12-7-04
CHECKING 41-474-3
ESTATE OF VICTORIA V HACKENBERGER
DANIEL L HACKENBERGER GUARDIAN
OPEN: 10-7-02
INT RATE: .60%
ODD BAL: $14,850.93
DOD INT: 2.20
IF YOU REQUIRE ANY FURTHER INFORMATION, PLEASE FEEL FREE TO CONTACT US.
SINCERELY,
'-f~Ci/~ ~e~--.r
BARBARA RECHER
CUSTOMER SERVICE
PSECI(;
the financial /ink TM
January 31,2005
Account # 8503679352
HOWARD B KRUG
1719 NORTH FRONT ST
HARRISBURG, PA 17102-2392
Dear MR KRUG:
The following is the status ofVICTORlA V HACKENBERGER's account with PSECU as of the date of death.
Joint Owner's Name
Date of Death
Date of Birth
NONE - GUARDIANSHIP ACCOUNT
12.01.2004
0712.1921
Share
SOl
S 04
Description
Regular Shares
Checking
Open date
11.01.2004
11.01.2004
Balance
$60,036.99
10,002.05
Accrued Dividend
$0.00
0.00
The dividend earned from November 1, 2004 through the date of death was $39.04. The decedent had no loans with
us. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in
Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227.
Sincerely, /
~7
Meacie Fairfax
Member Service Representative
Finance Support Unit
PENNSYLVANIA STATE EMPLOYEES CREDIT UNION
Main Address: 1 Credit Union Place, Harrisburg. PA 17110-2990 . (717) 234-8484 . (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013. (717) 777-2100 (TOO) . (800) 472-1967 (TOO)
Web Address: www.psecu.com
Savings federally insured up to $100,000 by the National Credit Union Administration.
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Trust Your Special Moments To Mountz.
July 29,2005
Dan Hackenberger
308 Third Street
Summerdale, P A 17093
Dear Mr. Hackenberger,
At your request I examined the jewelry you submitted for valuation and have provided an opinion of the
Fair Market Value.
This report is valid only in its entirety and the final figure excludes any applicable taxes. You may wish to
take this into consideration when using the report. The value conclusions are subject to limiting conditions
that are set forth in the body of the report. To the best of my knowledge and experience, I estimate the
jewelry has a total Fair Market Value of$305.00.
Photographs are included with the original report for your reference. I suggest that you keep your copy of
this report in a safe place.
This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice
(USP AP).
IfI can be of any further assistance, please call.
Sincerely,
~
Helen E. Rider
Enclosures
~
~
4520 Jonestown Road · Harrisburg, PAar7lo<?f1 (717) 545-7508 · Fax (717) 545-9353
www.mountzjewelers.com
'i"
ROLEX
Table of Contents
. Letter of Transmittal
. Table of Contents
. Purpose
. Intended Use
. Definition of Fair Market Value
. Approach to Value
. Market
. Limiting Conditions
. Subscriptions Retained for Value Consulting
. Metal Markets
. Certification
. List of Laboratory Instruments
. Item Descriptions
This report is valid only in its entirety and for its stated purpose and intended use and was prepared in
accordance with the Uniform Standards of Professional Appraisal Practice (USPAP).
Statements and Limiting Conditions
Purpose
The purpose of this report is to describe and document the quality of the jewelry listed and to estimate its
Fair Market Value.
Intended Use
The intended use of this report is for providing an estate appraisal listing the Fair Market Value for use in
the resolution of the Victoria Hackenberger Estate.
Valuation Date:
Definition of Fair Market Value
The fair market value is the price at which the property would change hands between a willing buyer and
willing seller, neither being under any compulsion to buy or sell and both having reasonable knowledge of
relevant facts. The fair market value ofa particular item of property... is not to be determined by a forced
sale price. Nor is the fair market value ofan item of property to be determined by the sale price of the item
in a market other than that in which such item is most commonly sold to the public, taking into account
location of the item wherever appropriate. Taken from Treasury Regulation 20.2031-1 (b)
Approach to Value
There are three traditional approaches to value that are as follows:
Income approach: Applies to income producing properties and is used only if an income situation or rental
property can be identified.
Market Data approach: Compares the qualities of the subject item to an article with similar or identical
qualities, and researches and records current verifiable sales of such merchandise.
Cost approach: Establishes the total value of an item by considering the value of its component parts
(precious metal content, gemstone weights and qualities, labor, and any other fees) together with the
appropriate retail markup according to the norms of the jewelers in the locale, supply and demand, and the
current state of the marketplace.
Page 2 of7
Fair Market Value is estimated using the market data approach. Neither the income approach nor the cost
approach apply in establishing Fair Market Value. However, the cost approach to value was used to check
on the reasonableness or market values found.
Market
To value an item a market (and market level) must be recognized. The most appropriate market for jewelry
can vary depending upon the article's age, condition, quality, intrinsic content, aesthetic appeal,
provenance, current fashion trends, artistic interpretation, period of manufacture among others.
The type of retail outlet that most commonly carries the items being appraised is considered to be the most
appropriate market. However, the auction market was also considered as another appropriate market in
establishing Fair market Value for this type of jewelry.
Limiting Conditions
The jewelry described within has been analyzed and graded in accordance with prescribed grading
standards using "state of the art" methods and precision laboratory equipment.
Jewelry constructed solely of, or in combination with, precious metals (i.e. platinum, palladium, yellow or
white gold and/or silver) is tested, analyzed and described for its type and content of such metal. Unless
otherwise stated, all gemstone weights, grades and measurements are approximate and stones have not been
removed from their mountings.
Diamonds are graded with the prescribed grading nomenclature of the Gemological Institute of America
(GIA) and the use of pre-graded permanent master diamond color comparison stones.
Colored stones are color graded with the use of the GIA Gem Set color grading system. Unless otherwise
stated, all colored stones listed on this appraisal report have probably been subjected to various treatments
to improve their appearance. Treatments are considered usual and customary practices when properly
disclosed and when done without intent to defraud the consumer. The treatments are mostly stable and do
not require special care. When a treatment is detected and considered unusual it will be so noted by this
appraiser. Some treatments are reversible and re-treatable. It may be beyond the scope of an appraisal to
determine exact treatment methods or the amount of treatment present. Some treatments require
sophisticated equipment not found in a standard gemological laboratory. Prevailing market values are
based on these universally practiced and accepted processes by the gems and jewelry trade.
Sources are assumed to be reliable and the appraiser does not assume responsibility for their information.
The appraiser assumes the ownership of the subject property is true as stated by the client.
The fees paid for this appraisal do not include the services of the appraiser for any other matter. In
particular, fees paid to date do not include any of the appraiser's time or services in connection with any
statement, testimony or other matters before an insurance company, its agents, employees or any court or
other body in connection with the property herein described.
If the appraiser is required to testify or to make any statements to a third party concerning the described
property and/or appraisal, the applicant shall pay the appraiser for all of such time and services so rendered.
This document is limited to its stated intended use and is invalid if all items listed in the Table of Contents
are not present.
Unless expressly stated, the items appraised are in good condition. Any serious deficiencies and repairs are
noted. Ordinary wear and tear is not noted.
The information in this report is confidential.
Page 3 of7
This appraisal process does not discover liens, encumbrances, or fractional interests but, if known, they are
noted.
The limited owner of this appraisal is the party for whom the work was performed.
Possession of this report does not provide title to the items appraised.
Possession of this report, any portion of this report, or any copy thereof, does not include the right of
publication without the appraiser's written consent.
Use of the information contained in the appraisal is invalid if all items listed in the Table of Contents are
not present.
Each item described in this report has been photographed and file copies of the photograph(s) as well as a
copy of the report are maintained in the appraiser's files for at least five years after the report date.
Third parties may rely on the information in this report for the defined purpose and intended use only.
Third parties requiring further information than what is in the report must obtain the written permission of
the owner of the appraisal before the appraiser will discus the report.
No changes may be made to this report by anyone other than the appraiser. The appraiser cannot be
responsible for unauthorized alterations.
The professional relationship between the appraiser and the client ends with the delivery of this report.
Subscriptions Retained for Value Consulting
Drucker, Richard - The Guide. Northbrook, IL
Rapaport, Martin - Rapaport Diamond Report. New York, NY
Metal Market
Gold
Silver
Platinum
7/29/2005
$431.50
List of Laboratory Instruments
Binocular microscope Leveridge gauge
Electronic scale Thermal conductivity diamond tester
Touchstone and acids Ultraviolet light unit
Polariscope Dichroscope
GIA Gem Set color grading system Refractometer
Diamond light and graded master comparison diamonds
Page 4 of7
Certification
. I hereby certify that, to the best of my knowledge and belief
. The statements of fact contained in this report are true and correct.
. The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting
conditions, and are my unbiased professional analysis, opinions, and conclusions.
. I have no present or prospective interest in the property that is the subject of this report and I have no personal
interest or bias with respect to the parties involved.
. My compensation is not contingent upon the development or reporting of a predetermined value or direction
in value that favors the cause of my client, the amount of the value estimate, the attainment of a stipulated
result, or the occurrence of a subsequent event.
. I have made a personal inspection of the property that is the subject of this report.
. No one provided significant professional assistance to the person signing this report.
. My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity
with the Uniform Standards of Professional Appraisal Practice.
He[~~~
7/29/2005
Page 5 of7
Prepared For:
Dan Hackenberger
308 Third Street
Summerdale, PA 17093
Date: 7/29/2005
Item 1
Ring
One lady's diamond engagement ring. This ring is set with one round brilliant cut diamond in a 4.9mm
round, white gold illusion head. The shank of the ring is yellow gold, measures 2.4mm wide on top and
1.75mm at the base.
Diamond Attributes
Shape and cut:
Measurements:
Weight:
Clarity:
Color:
Fluorescence:
Item Attributes
Weight:
Metal:
Finish:
Setting:
Trademark:
Condition:
Round brilliant
3.32 x 3.30 x 2.00 mm (approximate)
0.13 as. (estimated)
SI-2
F
None
2.492 gms
14K yellow and white gold
Polished
F our prong set
'14K FLAIR CO.'
Good
Total Approximate Fair Market Value Excluding Tax
$135.00
Item 2
Ring
One lady's ruby and diamond band. This band is set with five round, faceted rubies alternating with four
round diamonds across the top. The rubies and diamonds are set in shared prongs positioned NSEW. The
band measures 3.4mm wide on top and tapers to 1.8mm at the base.
Ruby Melee Attributes
Shape and cut:
Number:
Total Weight:
Diamond Melee Attributes
Shape and cut:
Number of diamonds:
Total Weight:
Clarity:
Color:
Item Attributes
Weight:
Metal:
Finish:
Setting:
Trademark:
Condition:
Round faceted, 1.8 to 1.9mm each
5
.30 cts. (estimated)
Round full cut, 2.2mm
4
.16 cts. (estimated)
SI
I-J
1.51 gros
14K yellow gold
Polished
F our prong set
'14K JTC 969'
Good
Page 6 of7
Total Approximate Fair Market Value Excluding Tax
$170.00
Total Approximate Fair Market Value for All Items - Excluding Tax: $305.00
Three hundred five dollars and no cents
Signature of Appraiser:
~_..
Helen E. Rider
Page 7 of7
08/19/2005 02:25
71 7-957-2077
SHALON I S FUr~ERAL HOM
PAGE 03
Michael J. Shalonis Funeral Home
206 Maple Avenue
Marysville, Pennsylvania] 7053
Phone (717) 957-3451
Fax (717)-957-2077
Michael J Shalonis, Own.er
Friday, December 17,2004
Mr. Daniel L. Hackenberger
308 Third Street, P.O. Box 232
Summerdale, PAl 7093
Dear Mr. Hackenberger,
Thank you for selecting our funeral home to provide services for you. I hope that you found our services, so far, [0 be
of the highest standards that we always try to achieve. The following is a summary of tne service charges as
previously explained and provided in written form on the services for Victoria V. Hackenberger:
Professional Sen'ic~s, Facilities & Automotin
Services Of Fum:ral Director And Staff
Embalming
DreSSing, CaskerlOg
Un Of facilities And Equipment
Use Of Fllcilitjes For Viewing / ViSItation
Staff & Equipment For Church Service
Automotive Equipmellt
Transfer Remains To Funera.l Home
Hearse (funeral Coach)
family Car
TOTAL OF PROFESSIONAL SERVICES.
FACILITIES ANO AUTOMOTIVE EQUIPMENT
Funeral M~rch8ndise
Casket Batesvile--Oxford Poplar
Outer Burial Container Gravcbox
Acknowledgement Cards
Register Book
Memorial Folders 125
CASH ADVANCED FOR YOUR CONVENIEl"CE
Cemetery/Crypt Opening and Closing
Newspaper Notiees
Out of 1'(\"0 Newspaper 'Notices
Clergv Honorarium
Certified Copies of Death Certificate 20
Flowers
Cemetery equIpment
Organist .
PCCW DonatIon
Luncheon
TOTAL FUNERAL CONTRACT
LESS: Credits granted
Discount allowed
LESS: Total Payments
LESS: Refund of Overpayment
PAID IN fULL
If there are any questions or concerns that remain unanswcred.. please call me.
Sincerely,
Michael J. Shalonis
Owner
$ 1083.00
,$ 375.00
$ 17500
$1,633.00
$ 235.00
$ 350 00 1585.00
$ 14.5.00
$ 155,00
$ 39000
$690.00
$2,908.00
$ U33.00
$580.00
$ included
$ Included
$ include<l
S2,1I3.00
$ 75000
S 256.76
$ 363./6
$ 150.00
$40 00
$ 290.00
$ 150.00
$ 100.00
$ 100.00
S 7518 $2,275.10
$7,296.10
$200.00
$200.00
$8.459.96
$1,363.86
$0.00
08/19/2005 02:25
71 7-957-2077
SHALONIS FUt~ERAL HOM
PAGE 04
Michael J. Shalonis Funeral Home
Michael J. ShalOl1is. (}-.tineI'
Friday, .December 17,2004
Mr. Daniel L. Hackenberger
308 Third Street. P.O. Box 232
Summerdale, PA 17093
206 Maple ,~venue
Marysville, Pennsylvania 17053
Phone (717) 957-345]
fax (717)-957-2077
Dear Mr. Hackenberger,
Thank you for selecting our funeral home to provide services for your family during your bereavement. I
hope that you found our services to be of the highest standards and that they met your needs and those
of your family and fnends.
The following is a summary of the service charges as previously explained and provided in written form
and herein indicated as PAID-iN-FULL
Victoria V. Hackenberqer
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
LESS: Credits granted
LESS Total Payments
LESS: Refund of Overpayment
CURRENT BALANCE
Credits Granted $200.00 Discount allowed
If there are any questions or concerns that remain unanswered, please call me.
Sincerely,
Michael J. Shalonis
Owner
$7,296.10
20000
8,459.96
1,363.86
$0.00
REV-15f1 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
HACKENBERGER VICTORIA V.
FILE NUMBER
21
04
1196
ITEM
NUMBER
A.
1.
2.
3.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
11.
12.
13.
15.
16.
-
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Michael J. Shalonis Funeral Home (Jt. CD with funeral home)
Engraving of head stone (Frank Snyder)
Dry cleaners (clothing for funeral)
7,096.10
121 .00
24.30
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Daniel L. Hackenberger
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address P.O. Box 232
City Summerdale State PA Zip 17093
Year(s) Commission Paid: 2005
18,778.15
Attomey Fees PURCELL, KRUG & HALLER
4,478.75
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
Probate Fees Cumberalnd County Register of Wills
366.00
Accountanfs Fees Norman Morrow, CPA
85.00
Tax Retum Preparer's Fees
Sentinel - Advertising fees
Cumberland Law Journal - Advertising fee
Mountz Jewelers - Appraisal fee
Inheritance Tax Return - filing fee
Estate checking account - bank charges
Office supplies & obituary (Kmart; Office Max)
Family Settlement Agreement - filing fee
Executor mileage
2004 mileage 101.8 @ $.37.5 = $38.18
2005 mileage 299.9 @ $.40 = $119.96
64.43
75.00
1 00.00
15.00
1.00
23.52
25.00
158.14
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
31,411.39
-
Milea2;e for the Estate of Victoria Hackenber2;er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
12/17/04 Funeral Director 60,301 60,308 7.0
12/30/04 Cumberland Co. Court 60,433 60,474 41.0
12/30/04 Perry Co. Court 60,474 60,528 53.8
Total Mileage for 2004 101.8
1/04/05 Krug 60,561 60,571 9.4
1/05/05 Krug 60,583 60,592 9.4
1/07/05 Morrow 60,621 60,675 53.7
1/27/05 Perry Co. Court 60,832 60,886 53.8
2/16/05 Taxes 61,731 61,785 53.7
2/17/05 Taxes 61,798 61,852 53.7
2/22/05 Krug 61,023 61,033 9.4
3/08/05 Krug 61,281 61,291 9.4
7/23/05 Mountz Jewelers 68,553 68,564 11.0
8/01/05 Mountz Jewelers 68,678 68,689 11.0
8/16/05 Krug 68,751 68,761 9.4
8/26/05 Krug 68,821 9.4
Total Mileage for 2005 293.3
TOTAL MILEAGE - Executor 395.1
EXECUTOR MILEAGE
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HACKENBERGER. VICTORIA V.
FILE NUMBER
21
04
1196
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Department of Public Welfare lien (Class 6)
Estate Recovery Program
CIS#220147441
2. Daniel Hackenberger, Guardian (mileage expense)
9/2/2002 - 12/31/2002 1,550 miles X $.37 per mile = $573.50
Calendar year 2003 2,997 miles X $.365 per mile = $1,093.91
01/1/2004 - 12/4/2004 2,225 miles X $.375 per mile = $834.38
VALUE AT DATE
OF DEATH
144,561.79
2,501.79
3. Neighborcare - medical bill/healthcare
194.49
4. Manorcare Carlisle - medical bill/healthcare
712.74
5. Adams - Cumberland Medical Center - medical/healthcare
60.71
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
148031.52
Mileae;e for the Guardian of Victoria Hackenbere;er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
9/8/02 Farm 19,418 19,443 24.4
9/13/02 Morrow 19,812 19,866 53.7
9/13/02 Manor Care 19,866 19,907 41.7
9/14/02 Farm 46,183 46,208 24.4
9/20/02 Morrow 20,421 20,475 53.7
9/21/02 Farm 20,407 20,432 24.4
9/22/02 Farm 20,432 20,457 24.4
9/25/02 Farm 20,611 20,636 24.4
9/26/02 Farm 20,651 20,676 24.4
9/28/02 Farm 20,693 20,718 24.4
9/28/02 Farm 20,718 20,742 24.4
9/30/02 POC - Mech. 20,801 20,829 28.0
9/30/02 Farm 20,829 20,854 24.4
10/2/02 Manor Care 20,912 20,954 41.7
10/2/02 Farm - True Value 20,954 20,986 32.2
10/3/02 POC - Meeh. 21,042 21,070 28.0
10/3/02 Farm 21,070 21,095 24.4
10/4/02 1 st National 46,392 46,398 6.4
10/5/02 Farm 21,351 21,376 24.4
10/6/02 Farm 21,401 21,405 24.4
10/7 /02 Farm 21,489 21,514 24.4
10/8/02 Farm 21,699 21,724 24.4
10/9/02 Farm 21,784 21,809 24.4
10/11 /02 1 st National 46,421 46,428 6.4
10/11/02 Farm 21,842 21,867 24.4
10/12/02 Farm 21,870 21,894 24.4
10/13/02 Farm 21,911 21,935 24.4
10/14/02 Farm 22,005 22,030 24.4
10/15/02 Farm 22,201 22,226 24.4
10/18/02 Farm 22,553 22,578 24.4
10/19/02 Farm 22,715 22,729 24.4
10/20/02 Farm 22,752 22,776 24.4
10/21/02 Lowes 22,830 22,845 14.8
10/23/02 Manor Care 46,580 46,625 44.7
10/23/02 Farm 22,910 22,935 24.4
10/24/02 Farm 22,991 23,016 24.4
10/26/02 Farm 23,090 23,102 12.2
10/27/02 Farm 23,102 23,114 12.2
10/28/02 Carpet Mart - Farm 23,222 23,260 38.6
10/29/02 Farm 23,312 23,337 24.4
10/30102 Farm 23,380 23,401 24.4
TOTAL MILEAGE - THIS PAGE 1,073.1
2002
Mileae;e for the Guardian of Victoria Hackenbere;er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
11/2/02 Farm 23,481 23,493 12.2
1113/02 Farm 23,493 23,505 12.2
11/4/02 1 st National 46,786 46,792 6.4
11/4/02 Farm 23,599 23,623 24.4
11/6/02 Farm 23,773 23,798 24.4
1117/02 Farm 23,890 23,915 24.4
1119/02 Farm 24,104 24,153 48.8
11/10/02 Farm 24,180 24,204 24.4
11/11102 Farm 24,221 24,246 24.4
11113/02 Farm 24.312 24,337 24.4
11/14/02 Farm 24,344 24,369 24.4
11/15/02 Farm 24,400 24,425 24.4
11/16/02 Farm 24,441 24,453 12.2
11/17/02 Farm 24,453 24,466 12.2
11119/02 Farm 24,663 24,688 24.4
11120/02 Farm 24,712 24,736 24.4
12/2/02 Farm 46,906 46,931 24.4
12/6/02 1 st National 46,950 46,957 6.4
12/6/02 Farm 25,289 25,301 12.2
1217/02 Farm 25,301 25,338 36.6
12/10/02 Farm 25,391 25,416 24.4
12/11102 Farm 25,431 25,456 24.4
TOTAL MILEAGE - THIS PAGE 476.4
TOTAL MILEAGE - 2002 1,549.5
2002 - Continued
Milea2e for the Guardian of Victoria Hackenber~er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
1/7/03 Farm 27,389 27,404 24.4
1/9/03 Farm 27,442 27,467 24.4
1111/03 151 National 27,521 27,527 6.4
1/12/03 Farm 27,543 27,567 24.4
1/18/03 Farm 27,791 27,816 24.4
1/25/03 Farm 28,099 28,124 24.4
1/27/03 Manor Care 47,489 47,531 41.7
1/29103 Morrow 28,622 28,676 53.7
1/29/03 Manor Care 28,685 28,727 41.7
2/1/03 Farm 28,854 28,879 24.4
2/8/03 151 National 47,801 47,807 6.4
2/8/03 Farm 47,815 47,840 24.4
2/10/03 Morrow 29,201 29,255 53.7
2/13/03 Morrow 29,431 29,485 53.7
2/14103 Taxes 29,522 29,576 53.7
2/20/03 Farm 29,943 29,968 24.4
2/27/03 Farm 30,350 30,375 24.4
3/1/03 Farm 30,522 30,534 12.2
3/2/03 Farm 30,534 30,547 12.2
3/7 /03 Farm 30,651 30,676 24.4
3/10/03 151 National 30,781 30,787 6.4
3/12/03 Manor Care 30,881 30,926 44.8
3/15/03 Farm 31,061 31,086 24.4
3/16/03 Farm 31,134 31,159 24.4
3/19/03 Farm 31,571 31,596 24.4
3/25/03 Perry County Court 49,012 49,066 53.8
4/4/03 Farm 49,208 49,232 24.4
4/5/03 151 National 49,246 49,253 6.4
4/12/03 Farm 49,421 49,433 12.2
4/13/03 Farm 49,433 49,446 12.2
4/18/03 Farm 33,781 33,806 24.4
4/26/03 Farm 33,912 33,936 24.4
5/3/03 Farm 34,001 34,026 24.4
5/7/03 Farm 34,068 34,093 24.4
5/9/03 151 National 50,281 50,288 6.4
5/12/03 Farm 34,232 34,256 24.4
5/18/03 Farm 34,330 34,354 24.4
5/25/03 Farm 34,486 34,510 24.4
6/5/03 Farm 34,921 35,045 24.4
6/6/03 Farm 35,093 35,118 24.4
6/12/03 Farm 35,241 35,265 24.4
TOTAL MILEAGE - THIS PAGE 1,063.2
2003
2003 - Continued
Milea~e for the Guardian of Victoria Hackenberger
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
6/13/03 1 st National 51,156 51,163 6.4
6/13103 Farm 35,279 35,303 24.4
6/18/03 Farm 35,381 35,405 24.4
6/19103 Farm 51,203 51,228 24.4
6/23/03 Farm 35,612 35,637 24.4
7/2/03 Farm 35,839 35,864 24.4
7/3/03 Farm 35,991 36,015 24.4
7/4/03 Farm 36,051 36,100 48.8
7/5/03 Farm 36,338 36,363 24.4
7/1 0/03 Farm 36,410 36,434 24.4
7/11/03 Farm 36,472 36,497 24.4
7/14/03 1 st National 51,521 51,528 6.4
7/16/03 Farm 36,711 36,736 24.4
7/17/03 Farm 36,851 36,876 24.4
7/24/03 Farm 37,124 37,149 24.4
7/25/03 Farm 37,207 37,232 24.4
7/29/03 Farm 37,383 37,408 24.4
8/2/03 Farm 37,520 37,545 24.4
8/3/03 Farm 37,586 37,610 24.4
8/11/03 Farm 37,811 37,836 24.4
8/12/03 Farm 37,884 37,909 24.4
8/15/03 I st National 51 ,90 1 51,907 6.4
8/18/03 Farm 38,091 38,116 24.4
8/25/03 Farm 38,297 38,321 24.4
8/26/03 Farm 38,358 38,383 24.4
8/29/03 Farm 38,488 38,513 24.4
8/30/03 Farm 38,543 38,592 48.8
9/1/03 Farm 38,622 38,671 48.8
9/5/03 Farm 38,711 38,736 24.4
9/6/03 Farm 38,748 38,797 48.8
9/6/03 I st National 38,797 38,804 6.4
917/03 Farm 38,822 38,847 24.4
9/12/03 Farm 38,940 38,965 24.4
9/13/03 Farm 38,971 39,020 48.8
9/14/03 Farm 39,036 39,060 24.4
9/17/03 Manor Care 52,131 52,175 44.8
9/20/03 Farm 39,081 39,105 24.4
9/22/03 I st National 52,208 52,214 6.4
9/24/03 1 st National 39,148 39,154 6.4
9/26103 Farm 39,191 39,216 24.4
9/27/03 Farm 39,259 39,308 48.8
TOTAL MILEAGE - THIS PAGE 1,059.2
-
Mileae:e for the Guardian of Victoria Hackenbere:er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
9/28/03 Farm 39,331 39,356 24.4
10/2/03 Farm 39,480 39,505 24.4
10/3/03 Farm 39,531 39,556 24.4
10/7 /03 Farm 52,545 52,569 24.4
10/10/03 1 sl National 52,592 52,599 6.4
10/10/03 Farm 39,738 39,762 24.4
10/11/03 Farm 39,791 39,840 48.8
10/12/03 Farm 39,866 39,915 48.8
10/13/03 Farm 39,966 39,990 24.4
10/14/03 1 sl National 52,634 52,641 6.4
10/16/03 1 sl National 52,663 52,669 6.4
10/17/03 Farm 40,084 40,109 24.4
10/17/03 1 sl National 40,115 40,121 6.4
10/18103 Farm 40,153 40,178 24.4
10/19/03 Farm 40,198 40,223 24.4
10/24/03 Farm 40,388 40,413 24.4
10/25/03 Farm 52,891 52,916 24.4
10/26/03 Farm 40,451 40,476 24.4
11/1/03 Farm 40,673 40,698 24.4
11/2/03 Farm 40,715 40,740 24.4
11/4/03 1 sl National 52,987 52,9994 6.4
11/8/03 Farm 41,007 41,032 24.4
11/9/03 Farm 41,071 41,096 24.4
11/10/03 1 st National 53,018 53,025 6.4
11/11/03 Farm 41,158 41,183 24.4
11/15/03 Farm 41,335 41,360 24.4
11/16/03 Farm 41,389 41,414 24.4
11/22/03 Farm 41,588 41,613 24.4
11/28/03 Farm 41,940 41,965 24.4
11/29/03 Farm 41,974 41,999 24.4
11/30/03 Farm 42,009 42,034 24.4
12/6/03 Farm 42,171 42,196 24.4
12/7/03 Farm 42,211 42,235 24.4
12/13/03 Farm 42,367 42,392 24.4
12/14/03 Farm 42,410 42,434 24.4
12/21/03 Farm 42,616 42,641 24.4
12/22/03 1 st National 53,444 53,450 6.4
12/27/03 Farm 42,793 42,818 24.4
12/28/03 Farm 42,839 42,864 24.4
TOTAL MILEAGE - THIS PAGE 874.4
TOTAL MILEAGE - 2003 2,996.8
2003 - Continued
Milea2e for the Guardian of Victoria Hackenber2er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
1/2/04 1 sl National 42,981 42,987 6.4
1/10/04 Farm . 43,271 43,296 24.4
1/14/04 Farm 43,463 43,488 24.4
1/19/04 Farm 43,587 43,612 24.4
1/22/04 Farm 43,793 43,818 24.4
1/31/04 Farm 43,972 43,996 24.4
217/04 Farm 44,181 44,206 24.4
2/8/04 Farm 44,233 44,257 24.4
2/9/04 1 sl National 44,281 44,288 6.4
2/13/04 Morrow & Taxes 44,388 44,442 53.7
2/14/04 Taxes 44,471 44,525 53.7
2/15/04 Farm 44,567 44,592 24.4
2/16/04 Farm 44,681 44,706 24.4
3/4/04 Farm 45,131 45,155 24.4
3/6/04 1 sl National 45,212 45,219 6.4
3/20/04 Farm 45,611 45,636 24.4
3/25/04 Perry County Court 45,791 45,845 54.0
3/26/04 Manor Care 54,286 54,328 41.7
3/27/04 Farm 45,908 45,933 24.4
3/28/04 Farm 45,998 46,023 24.4
3/29/04 1 sl National 46,107 46,114 6.4
4/2/04 1 sl National 46,211 46,218 6.4
4/10/04 Farm 46,371 46,396 24.4
4/13/04 Farm 46,511 46,536 24.4
4/1 7/04 Farm 46,896 46,921 24.4
4/18/04 Farm 46,961 46,985 24.4
4/19/04 Farm 47,015 47,040 24.4
4/21/04 Perry County Court 47,121 47,175 54.0
4/22/04 Farm 47,185 47,209 24.4
4/24/04 Farm 47,261 47,286 24.4
4/25/04 Farm 47,311 47,336 24.4
4/26/04 Farm 47,371 47,395 24.4
4/27/04 Farm 47,420 47,445 24.4
4/29/04 Farm 47,781 47,805 24.4
4/30/04 Farm 47,831 47,855 24.4
511/04 Farm 47,944 47,969 24.4
5/2/04 Farm 48,108 48,132 24.4
5/3/04 Farm 48,301 48,326 24.4
5/4/04 Farm 48,381 48,406 24.4
5/6/04 Farm 48,493 48,517 24.4
5/7 104 Farm 48,543 48,568 24.4
TOTAL MILEAGE - THIS PAGE 1,045.5
2004
. .
Milea2;e for the Guardian of Victoria Hackenber2;er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
5/8/04 1 sl National 48,584 48,590 6.4
5/8/04 Farm 48,590 48,615 24.4
5/9/04 Farm 48,623 48,647 24.4
5/11/04 Farm 48,761 48,786 24.4
5/13/04 Farm 48,831 48,856 24.4
5/14/04 Farm 48,864 48,889 24.4
5/15/04 Farm 48,928 48,953 24.4
5/16/04 Farm 48,977 49,002 24.4
5/17104 Farm 49,011 49,035 24.4
5/18/04 Farm 49,058 49,072 24.4
5/19/04 Farm 49,098 49,123 24.4
5/22/04 Farm 49,171 49,196 24.4
5/23/04 Farm 49,203 49,228 24.4
5/25/04 Farm 49,251 49,276 24.4
5/27/04 Farm 49,312 49,336 24.4
5/28/04 Farm 49,347 49,372 24.4
5/29/04 Farm 49,398 49,423 24.4
5/30/04 Farm 49,455 49,480 24.4
5/31/04 Farm 49,497 49,521 24.4
6/1 /04 Farm 49,539 49,564 24.4
6/3/04 Farm 49,601 49,625 24.4
6/4/04 Farm 49,632 49,657 24.4
6/5/04 Farm 49,669 49,694 24.4
6/6/04 Farm 49718 49742 24.4
6/7/04 1 sl National 49,787 49,794 6.4
6/7/04 Farm 49,794 49,818 24.4
6/9/04 Farm 49,854 49,879 24.4
6/10/04 Farm 49,891 49,916 24.4
6/11/04 Farm 49,935 49,960 24.4
6/12/04 Farm 49,987 50,011 24.4
6/13/04 Farm 50,044 50,068 24.4
6/14/04 Farm 50,094 50,119 24.4
6/15/04 Farm 55,831 55,844 12.2
6/16/04 Manor Care 55,844 55,863 18.9
6/1 7/04 Farm 55,863 55875 12.4
6/18/04 Farm 50,461 50,473 12.2
6/19/04 Farm 50,473 50,485 12.2
6/20/04 Farm 50,513 50,538 24.4
6/21/04 Farm 50,584 50,609 24.4
6/26/04 Farm 50,884 50,908 24.4
7/6/04 1 sl National 50,994 51,001 6.4
TOTAL MILEAGE - THIS PAGE 892.3
2004 - Continued
.. '. .
2004 - Continued
Mileae;e for the Guardian of Victoria Hackenbere;er
DATE DESTINATION CHEVY JEEP MILAGE
START END START END
7/9/04 1 sl National 51,112 51,118 6.4
7/24/04 Farm 51,885 51,909 24.4
817/04 1 sl National 52,321 52,328 6.4
817/04 Farm 52,328 52,353 24.4
8/27/04 Farm 52,981 53,005 24.4
8/30/04 1 sl National 53,189 53,195 6.4
9/3/04 1 sl National 53,3 14 53,321 6.4
9/16/04 Farm 53,949 53,974 24.4
10/2/04 1 sl National 55,902 55,909 6.4
10/2/04 Settlement 56,105 56,146 40.8
1012/04 1 sl National 56,418 56,425 6.4
10/2/04 1 st National 56,693 56,699 6.4
11/1/04 PSECU 56,884 56,891 7.3
11/3/04 Manor Care 56,931 56,973 41.7
11/5/04 1 sl National 57,191 57,198 6.4
11/8/04 Carlisle Hospital 57,313 57,355 42.3
12/4/04 1 st National 58,671 58,678 6.4
TOTAL MILEAGE - THIS PAGE 287.3
TOTAL MILEAGE - 2004 2,225.1
. ""~"",,. '.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HACKENBERGER VICTORIA V.
NUMBER
I.
SCHEDULE J
BENEFICIARIES
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Daniel L. Hackenberger
P.O. Box 232, Summerdale, PA 17093
FILE NUMBER
21 04
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
11QR
AMOUNT OR SHARE
OF ESTATE
1/3 residuary estate
1/3 residuary estate
1/3 residuary estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Son
2.
Richard R. Hackenberger
33 Great Lakes Drive, S1. Peters, MO 63376-3225
Son
3.
William C. Hackenberger
P.O. Box 60361, Harrisburg, PA 17106-0361
Son
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
r
('[[i('C .cd"HERITANCE TAX
v 0-~CORD ADJUSTMENT
-, JOINTLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
2 r r'; - -=~ :~. ~.~ .... ~7 r:. T,
1. '/ n
,. c.... ~j
REX A GARMANr
1834 ANNA ST
NEW CUMBERLAND PA 17070
REV-1604 EX AFP (03-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
09-30-2005
GARMAN
12-02-2004
21 04-1146
CUMBERLAND
722-16-0091
05110722
Allount Rellitted
LAWRENCE
M
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
4-
------------------------------------------------------------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (03-05)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 09-30-2005
ESTATE OF GARMAN
COUNTY
CUMBERLAND
LAWRENCE M DATE OF DEATH 12-02-2004
ACN
05110722
FILE NO. 21 04-1146
ADJUSTMENT BASED ON:
S.S/D.C. NO. 722-16-0091
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SUSQUEHANNA VLY FCU
ACCOUNT NO. 47-00
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 05-10-2003
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
TAX CREDITS:
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .nn
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
L::- ~"11
REV-1470 EX (&-88)
'*
., )
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
FILE NUMBER
REVIEWED BY
ACN
2104-1146
05110722
LAWRENCE GARMAN
SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
The above referenced ACN has been reduced to zero, as this account was reported on the
probate return.
Paqe 1
10-10-2005
GARMAN
12-02-2004
21 04-1146
CUMBERLAND
101
APPEAL DATE: 12-09-2005
( 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
~~!_~~9~~_!~~~_~~~~______~___~~!~!~_~~~~~_~~~!!~~_~~~_y~~~_~~~~~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
LAWRENCE M FILE NO. 21 04-1146 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
D~PARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
(1 ,~, ,. i~
? -/
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
JAMES D BOGAR
BOGAR & HIPP LAW
1 W MAIN ST
SHIREMANSTOWN
OFCS
PA 17011
ESTATE OF
GARMAN
REV-1547 EX AFP (06-05)
LAWRENCE
M
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 10-10-2005
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
212,507.65 X 045 = 9,562.84
.00 X 12 = .00
.00 X 15 = .00
1I9)= 9,562.84
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estata (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
1I)
(2)
(3)
(4)
(5)
(6)
(7)
139,900.00
47,977.17
.00
.00
29.538.71
18,184.08
6,038.26
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
1I0)
28,754.21
376.36
(11)
(12)
(13)
1I4)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
241,638.22
29.130 57
212,507.65
.00
212,507.65
..~n. n~_~.. . l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-02-2005 CD005009 450.00 8,550.00
07-29-2005 CD005637 .00 562.84
TOTAL TAX CREDIT 9,562.84
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE.., {"
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) LI
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Lawrence M. Gannan
Date of Death: December 2, 2004
Will No.
21-04-1146
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:
1. State whether administration of the estate is complete:
Yes XX No
2. I f 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 XX
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 XX No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 12/14/05
James D. B r, Esquire
Name (Please. type or print)
One West Maln St.
Shiremanstown, PA 17011
Address
a
(Y')
C''oj
~_'J
(717) 737-8761
Te 1. No.
, -;-)
Capacity:
Personal Representative
x Counsel for personal
representative
(MAH:rmf/AM3)
V~