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J 1505610243
REV-1500 EX
DecedenPs Social Security Number
o�a�M�.Nama: HARTMAN, GERALD J.
RECAPITULATION
t. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonda(schedu�e e)............................................................................... z. 4 6 3 , 3 4 2 . 9 7
3. Closely Held Corporation,Partnership or Sole•Proprietorship(Schedule C).......... 3.
4. MoAgages&Noles Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposils&Miscellaneous Personal Property(Schedule E)................ 5. 1 , 1 7 5 . 0 0
6. Jointty Owned PropeAy(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miacellaneous Non-Probate Property
(scneduie c) ❑ Separata Biliing Requested............. 7. 2 5 , 7 2 9 . 0 8
8. 7ota1 Gross Asaeta(total Lines 1-7)....................................................................... 8. 4 9 O , 2 4 7 . 0 5
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9.
10. Debts of Decedent,Mortgage LiabilNies,&Liens(Schedu�e I)................................ 10.
11. Tohl Deductions(total Lines 9&101...................................................................... 11. 0 . 0 0
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 4 9 O , 2 4 7 . 0 5
13. Charilable and GovernmenWl Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13.
14. Net Value Sub)ect to Tax(Line 12 minus Line 13)................................................. 14. 4 9 O , 2 4 7 . 0 5
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at tM spousal tax rate,or
transfers under Sec.9116
(a)(1z)x .o0 490 , 247 . 05 �5 0 . 00
16. Amount of Lina 14 taxable
at lineal rate X .045 16�
17. AmouM of Line 14 taxable
atsiblingrateX ,�p »�
18. Amount of Line 14 taxable
at wllateral rate X .15 �8�
19. Tax Due..................................................................................................................... 19. O . O O
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21 - 12 - 01097
DecedenYs Complete Address:
Hartman, Gerald J.
STREETADDRESS
5285 Dogwood Court
CITY STATE ZIP
Mechanicsburg PA 77055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. CrediGSlPayments
A� Prior Payments
B. Discount
Total Credits(A +g) (2) 0.00
3. interest (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the diflerence. This is the OVERPAYMENT. (4)
Check boz on Page 2 Line 20 W request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the di%ren�. This is the TAX DUE. (5) �•0�
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTION3 BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make e transfer and: Yes No
a. retain the use or income of the property transterred:.................................................................................. x
b. relain ihe right to designate who shall use the property transferted or its income:.................................... x
c. retain a reversionary interest or................................................. x
d. receive the promise tor IHe of eitt�er paymenta,benefils or care9.............................................................. x
2. If dealh occurced efter December 12, 1982,did decedent transter property wHhin one year of death without
receiving adequate consideratron?....................................................................................................................... ❑ �
3. Did decedent own an"in trust fo�' or payable upon death bank account or securihl at his or her death?......... � �x
4. Did decedenf own an Individual Retirement Account,annuiry,or other non-probate property which
contains a beneficiary designation9...................................................................................................................... ❑x ❑
IF THE ANSWER TO ANY OP THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after JuIy 1, 1994 and before Jan.1, 1995,the tax rate imposed on the net value oi transfers to or for the use of the surviving
spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)1.
For datea of death on or after January t,1995,the taz rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
p2 P.S.§9116(a)(1.1)(ii)]. The atatute does not exempt a transfer to a surviving spouse from tax,and the stetutory requirements for disclosure of
assets and filing a Wx retum 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 impoaed on the net value of transfers from a deceased chiM 21ye ars of ege or younger at death to or for the use of a natural parenl,an
adoptive parent,or a steppa2nt of the chilU is 0 percenl(72 P,S.§9116(a)(1.2)].
•The tax rate imposetl on t�e net value of Vansfers to or for the use of the decedenPs lineal beneficiaries is 4.5 percent,excapt as noted in
72 P.S.§9't16 12)[72 P.S.§9116(a)(1)1.
•Tha tax ra�impoaed on the net value of transfers lo or for the use of the decedenPs siblings is 12 percent I�2 P.S.49116(a)(1.3)1. A
sibling is defined under Section 9102,as an irWividual who has at least one parent in common with the decedent,wfiether by blood or adoption.
� SCHEDULE B
canwar�vhxTM oF venNSrwuiw
STOCKS 8� BONDS
Ma�mru�cera<anuw+
RESIDEM OECEOENT
FILE NUMBER
ESTATE OF Hartman, Gerald J. 2t - t2 -0�09�
All property joiMy-owned wkh Hght of survWOrship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 Wells Fargo Investment Account 463,342.97
Number 1395�101
TOTAL(Also enter an Ilne 2,Recapitulatlon) 463,342.97
� SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
�«��TM�����^^�^ PERSONAL PROPERTY
IWIEFRNlCETW(RETURN
RE610ENi OECEOEM
FILE NUMBER
ESTATE OF Hartman, Geraid J. 2� - �2-o�os7
Include the proceeds of litigation and the date the proceeds were received by the eslate.All property Jolntly�owned with the right ot
surv�vo�shfp must be discloaed on schedule F.
NUM ER DESCRIPTION VALUE�AET�DHTE OF
1 1998 Chrysler LeBaron Convertible 1,175.00
VIN 1C38J45K7JG403476
Mileage 50,000; Condition: Good
TOTAL(Also enter on Line 5, Recapitulatlo�) 1,175.00
COMMONWEAL�NNSVLVANIF SCHEDULE G
INHERRANCETAXRENRN INTER-VIVOS TRANSFERS 8�
RESIDEMOECEDEM MISC. NON-PROBATE PROPERTY
ESTATE OF Hartman, Gerald J. FILE NUMBER
21 - 12-01097
This schedule must be completed and flled H the answer to any of questfons 1 through 4 on page 2 is yes.
ITEM DESCRIPT70NOFPftOPERTV DATEOFDEATH %OF �CLUSIIXJ
NUMBER Inclutlethenemeotihetrensferee,MeirnlefionahipfadecadeM yq�UEOFASSET INTEREffi OFAPPLIGABL� TAXABLEVAWE
entl tl�e tlate of tnnsfer. ACnch e wpy of the deed b�real estete.
1 Wells Fargo IRA �,��� 100°h 25,729.08
Beneficiary:Solita Hartman, Spouse of Decedent;
Payable upon DecedenYs Death
TOTAL(Also enEer on line 7,ReeapRulatbn) 25,728.08
REV•1573 EXF�11-08)
SCHEDULEJ
COMMONWEALTH OF PENNSVLVANIA BENEFICIARIES
INHERRANCE TA%RERIRN
RESIDEM DECEDEMf
ESTATE OF Hartman,Gerald J. FILE NUMBER
21 - 12-01097
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY oo rwe uae T�vanyq
I TAXABLE DISTRIBUTIONS�Inelude adrigM usal
dishibulions and��fers
under Sec.�116(a)(12)�
1 Solita L. Hartman Wife Entire 489,072.05
5285 Dogwood Ct.
Mechanicsburg, PA 17055
2
3
4
5
EMer dollar amouMs fa distributions shown above on lines 15 through 18 on Rev 1500 crner sheet,ae a�ropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9773 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
8.CHARITABIE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
INVENTORY
RKi18TER OF WILLS OF CUMBERLAND COUNTY, PENNSYI.VANIA
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FIGURE�AAIIST�TOTAI.ED
Psl�oml pron�rtv
YM�Ns Faepo Y�nt 1►000aM �iS.34Z.Y7
NtaebK 1�6�A101
1M!C�sbr L,�ron Co�w�rtlbM 1.175.00
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