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� 1505670243
REV-1500 EX
DecedenYs Social Securiry Number
o�tla�neNema: HARTMAN, SOLITA L.
RECAPITULATION
t. Real Estate(Schedule A).......................................................................................... 1.
2. Stotks and Bonds(Schedule B)............................................................................... 2. 4 E 5 , 4 6 6 . 3 3
3. Closely Held Corporetion,PaRnership or Sole-Proprietorship(SChedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5� Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 6 1 7 , 9 8 9 . 5 2
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Trensfere 8 Miacellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7. 5 6 � 8 5 0 . 3 1
8. Total Grosa Aasats(total Lines 1-7)....................................................................... 8. 1 � 16 0 , 3 0 6 . 16
9. Funerel Expenses&Administrative Costs(Schedule H)......................................... 9. 1 6 , 2 5 4 . 16
10. Debts of Decedent,Mortgage LiabilHies,&Liens(Schedule p................................ 10. 1 3 1 , 4 4 9 . 3 9
11. ToWI DedueGons(total Lines 9 8 10)...................................................................... 11. 1 4 7 , 7 0 3 . 5 5
12. Net Value of Eatate(Line 8 minus Line 11)............................................................. 12. 1 � 0 12 , 6 0 2 . 61
13. Charitabie and Govemme�tal Bequesta/Sec 9113 Trusts for which
an eledion to tax has not been made(Schedule J)................................................. �3. 3 5 � 0 0 0 . 0 0
14. Net Value SubJect to Tax(Line 12 minus Line 13)................................................. �4. 9 7 7 , 6 0 2 . 61
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 tauable
at the spousal tax rete,or
translers under Sec.9116
(a)(12)X.00 15.
16. Amount of Line 14 taxable
at�inea�rate x oa5 9 7 2 , 6 0 2 . 61 �s. 4 3 , 7 6 7 . 12
17. Amount of Line 14 taxable
alsiblingreteX ,�y ��
18. Amount of Line 14 taxable
at wllateral rate X .15 5 , 0 0 0 . 0 0 �e. 7 5 0 . 0 0
�s. raxDue..................................................................................................................... is. 44 , 517 . 12
20. FILL IN THE OVAL IF YOU ARE REQUESTINCa A REFUND OF AN OVERPAYMENT. ❑
Side 2
L 150b�10243 1505610243 J
REV-1500 EX Page 3 File Numbar 21 - 12 - 01212
QecedenYs Camplete Addr�s:
Hartman, Solita L.
STREETADQRESS �
5285 Dogwopd Court
C1TY STATE ZIP ~
Mechaniaaburg PA 17455
Tax Paynneirts and Credits:
1. Ta�cDue{Page2,�inet8) tt) dd,$17.12
2. Credfts/Payments
A. PriorPayments 39,400A0
$. Discaunt 2,073.6$
rotalCred�ts(A +B} (2S 41,473.68
3. Interest
caa o.oa
A, if i.ine 2 is greefer 2ihan Line 1+V�3,et�ter the diHerence. Thrs is tMe OYERPAYMfNT. {4}
Cha�ck box on Page Z Line 20 to requeat a refund —
5. if Line 1+Line 3 is greater than Line 2,enter the d'rfference. 7his i9 the TAX DUE. �5) ��04 3.4 d
Make Check Payable to: REGISTER OF WILLS, AGEM7.
PLEASE ANSWER THE FOLLQWING QUESTIONS BY PLACING AN "X" iN THE APPROPRIATE BLOCKS
1. Did tl9cedent make a trransfer and: Vua No
a. retain khe use or incane W the P�nY transfe�red:.................................................................................. x
b. reWin the dght to desgnate who shall use the property transferted or its income;........._....,._......_......... �
a retai�a reversronary intmrest:oc................................................................................................................. x
d. recaive the promisa for Iffe of either payme�ts,beneflts or care?_._......................................................... x
2. If deaih occurred after December 12, 1982,did decedent trensfer property within ona year pf death wilhout
receivPng adequate consfderotlon9....................................................................................................................... ❑ �
3. Did deOedeM oxm an"in trust foT or payable upon dsath bank account or securiy at his or her death?......,.. C] �x
4. Did d8cedeM am an indiv�vai Retirament AccauM,annutty,or c�her non-probate prflperty which
contaims a beneficiary desgnation7...................................................................................................................._ � ❑
iP THE ANStMER TO AMY 4F TkE A6QYE 4UESTION3 IS YE$,Y6U FAUST COb�IETE SCHEpULE G AND FILE IT A8 PART OF THE RETURN.
For datea of deaM on or sfter JuI�1,1994 and befiore Jan. 1,1995,ihe tax rete imposed on the net vaNe oi transfers to or for the use of the surviving
spouse is 3 perceot[72 P;S.§9116(a)(1.1)(i)1.
For dates of death on or�er JanuarY t,1995,the tax rafe imposed on tfie nat value of tr&nsfers to or for the use of the surviving spouse is 0 percent
[7Y P.S.§9716(a)(1.1) I ]. The stefute tloas nory exempt a transfer to a survNing spouse from t�,and the statutory requirements tor disclosure of
asseta arni filing a tax re m are si�t appti�s6ie aven H ttie surviving spouse is the only beneficiary.
For datea ot daath on or a(ter July 1,2000:
•The tax rate imposed on Ithe net value of transferts from a deceaxed chik121ye ars of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a sW�paront of the Gtild is 0 parcent(72 P.S.§4�t6(a}(t.2)].
�The t�rate impo8ed on he net value of transfe�a to or for tha use ot the decedenCa lirreal bene(ciaries is 4.5 percent,except as rroted in
7z�.s.§sx�s �z}�rz�.s=§sixata�{s)i.
�7ha ta�c rate imposed on�net value of transters to or for the use of the decedeM's sibii�s is 12 percent(72 P.S.§9t 1fi{a}{1.3}. A
sibiing is definad under ron 9102,ss an indNiduai who has at Ieest orre parent in eommon wdh tlre decadeM,wfieMer 6y bioo�or adoption.
_ _ _
� SCHEDULE B
ca.�am�wniocreru.�envnr+u STOCKS & BONDS
MNERRrWCETNtNE1UqN
RE91pENTDECEOEM �
ESTATE OF Hartman, SOIItB L. FILE NUMBER
21 - 12 -01212
All property Joi�tly-owned with rigM of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 LaPorte Asset Management 485,466.33
Welis Fargo Investment Account#78873249-1
TOTAL(Also enter on Iine 2,Recapitulation) 485 466.33
�
�
SCHEDULE E
CASH, BANK DEPOSETS, & M15C.
c�runioFpewurtvuaw PERSONAL PROPERTY �
M111ERITPNCE TAX REIURN
REeIC£NTpEGEOENT �
FILE FIUMBER
ESTATE OF Hartman, SO�ItB L. 2T _ �2_012�2
include thepraceeds of litig�and the date th�proceeds were received by the estate.AII p�serty JoiMiyowned with the rlght of
survivarship must be dis losed on schedu�e R.
ITEM DESCRIPTION � VALUE AT OATE OF
NUMBER DEATH
1 Metro Bank Acct.#513205765� 55,826.fi4
2 Estate of Ger�aid Nartman IRA Acxt.#4424-9148;transferred ta Solita ka�tman (vested on 87,873,82
11/03/2012)
3 Esiate of Gerald HaRman AccY.#1395-6141 456.928.34
Mc Hartman died an October 4, 2012. By his Will, Mrs. Hartman became entitled to the
account as ofl November 4, 2412{31 days after Mr. Flartman's death}. The value of the es#ate
interest as of!khe date of her death (11/09/2012) is reported.
4 2Q05 euick Century Sedan 6,412.04
VIN LG4HR511KK5UL5$293
5 2012 PA Income Tax Refund 33$.QO
6 2di2 Federaf income Tax F?efund 9,438A0
7 1988 Chrysler leBaron Convertibte 1,175.00
VIN 1C38J48K7JG403476
i
TOTAL(Alsa enter on tlraa 5,ReeapiWiaUon} $17,$$9.$2
I
COMMONWEALiHOFPENNSVLVqNIA SCHEDULE G
�NH�A�T,�R� INTER-VIVt�S TRANSFERS 8�
RE610ENTDECEDENT MIISC. NON-PROBATE PROPERTY
ESTATE O� Hartmsn,Solita L. �lLE NUMBER
21 - 12-81212
This sshedn�must tse aompiebed and flled iF ttre answer bo any of qaestians 1 through 4 on page 2 is yes.
ITEM I�IudeManamm�otNeb-a�eNree,Neirre�Rmonsn� md�ae�t OATEOFDEATN oECOS �aus�oN TAXABLEVALUE
NUMBER � VA4UEOFASSEf INTERE9T OFAPPUCABLE)
ond Me d9te oF er&nsFer. AtbcM e wpy d the deed Wr real ecmte.
1 Welis Fargo'1RA Acct#3177-7508:Distributed to Gary �,Q`�3� 100�i6 56,850.31
Hartman,Jaan Neijstrom and Judittr Hartman (Sister
Sharon); all Children of the decedent;interest
transferrabie upon death of Solita Hartman per her
IRA beneficiery designation.
TOTAL{Alao enter on line 7,Recapituiation} 56,850.31
��U.E�Hcc.p
coMMINNIFxni oF pEMww.vu�w �^�'^•cN'a77Cti70c
MHERITRNCE TN[RBTI1pN ��/y���t
REBIDEM DECEO@NT 4�N 1�7
ESTATE OF Nartman, SOlita L. FttE kUMBER
z� - �2-o�z�z
Debts of deoedent must be repprted on Schedule I.
17EM
NUMBER FUNERAL EXpEN8ES: ��SCR6PTION AM4UNT
A• 1 Neill Funeral HOme, Ic. 7,467.82
2 St Theresa Roman Ca�rolic Church �p.pp
B. ADMINISTRA77VE COSTS:
1, Persanai ReprPoSentative's Commiss6ons �
Name of Personai Representative(s)
Gary G. H�rtman
StreetAddress P.{J. Box 17119
Ciry Snowimass Village stace CO ziP 81615
Year(s)Commission paid
2. Aitomeys Fees Bgit, Mutren 8a Conne�� 3,500.00
3. Famity Exemption: (If dec»denPs address is not th�same as claimanPs,attach explanation}
Ciaimant
Street Address
Ciry state 2ip
Relationship of Cia"ananf to Decederrt
a. proba�e Fees Cumberland County Register of Wills gg�,gp
5. AccpuntanPa Feies
6. Tax Retum Preperers Fees
7. (7ther Administr9tive Costs
1 UGI
57.9$
TOTAL{Aiso enter an line 9,Recapitulation) qg�y$q,�g
ScF�dtieH
COMMONWEhLTN OF PEMNSYLVANIA ���
INHEpI7ANCETA%FETURN ��(��
RESIDENT DECE�ENi
ESTATE OF Hartman, SOlit2 l. FILE NUM6ER
21 - 12 -01212
2 West Shore Country Ciub i� i41.31
3 PP&L 102.12
4 Omnicare 100.46
5 Alpha Diagnostics 38,gB
8 PA Ametiqti Water 35.47
7 Omnicare 16025
8 AT&T 23.15
9 Bethany Village �,��,2p
9Q Verizart 3q,p7
11 Farmers InsuranCe 395.77
12 Wells Fargo Investment Management Fee 594.82
13 Premier Eye�are 22.8fi
14 Gumberiand Gau�ty R�ister of Wilis-shart certificates 20.00
15 Gary Hartman -Executor's Expehses (Reimbursement for meals, Iocai transportatian, 1,145A0
accomodations}
16 Reserve for adlministra#ion expenses(filing fees, Postage, reproduction} 200A0
17 Ball, Murren &�Connell-ReimbuCsement inr costs advanced 77.72
18 Reserve for addiGonal probate costs 150.qQ
Page 2 of Scheduie N
SCHEDULEI
DBBTS OF dECEDENT, MORTGAGE
C«.��,THOFPE�,,V,�a LIABILITIES
INHERITqNCETPXRETURN , & LIENS
RE&DEMOfCE�ENT
FILE NUMBER
ESTATE OF Hartman, Solita L. 21 - 12-012t2
Reporl debts incurred by tbe decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
I7EM
NUMBER DESCRIPTION AMOUNT
1 Messiah Uliage-Salita Hartman care 131,449.39
TOTAt{Aiso erder o�Line 10,Recapitulatlon} 131,A48.39
� � �
REV-0573 EXt(11-08) `F�'
seH�au�E �
caa�n+a+wE'Ain+oF aEwNSnvnNU BENEFICIARIES
�NHERRANCE TAX fdENRN
REBIbENT DECEDEM
ESTATE OF FILE NUMBER
Hartman,Solita C= 21 -12-01212
RELATIpNSHIP TO $HARE OF ESTATE AMOUNT OF ESTATE
NUM6ER NAME AND ADDRESS OF PERSON(S) DECEDENT (Wordn} {$$$)
RECEIVING PRQPER7Y ooewt�w�rn�aeets7
i� TAXABLE DISTRIBUTIONSjinefude ouMgM spousat
distribuho� end tranafers
under Sec.�116(a)(12)]
1 iCimberiyfiartman Granddaughfer �p,�p,pp
P.4.Box 17119
Snowmass�Ilage, CO 81615
2 Brian Hartman Grandsan 10.000:00
P.d. Box 17110
SnowmassWillage,CO 81615
3 Gary G. Hartman $on S6cteen and
P.O. Box 17719 iwa-thirds per cent
Snowmass Village,CO 81615
Enb�rkilar azrwunYs far shnVm abore ar�rres t5 tMough 18 rm Rev 1500 cxxrer a#ce�,a�s apprap�iate.
II. NON-TAXABLE DISTRIBUTIQNS:
A.SPdUSAL DI$7RIBUTI4N5 UNDER SECTION 9713 FOR WHICH AN EIECTION TO TAX IS NpT TAKEN
B.CHARITA9LE AND GOVERNMENTAL DISTRIBUTIONS
1 Salvation Army, 1122 Green Street, Harrisburg,PA 17102 5,0OO.Otl
2 Rmerican Red Cross, 1$04 Nartih Bth Sheet,Harrisburg, PA 17102 5,400.00
3 Gatholic RElie#Senrices,228 West leaangtan Street,8altimore,MD 21201 S,ppp.4p
4 ChrisUan Fqundation far Childreri &Aging, One Elmwood Drive, Kansas Cily, KS 66103 5,000.00
5 New Gumberland Public library,!1 Benjami�Piaza,New Cumberland,PA 17p�0;pius i5,00D.80
See attached
TOTAI.�PARTyI-ENTEft TOTAI NOI�t-TAXAB�E OISTRIBUTIOPIS ON llNE 13 4F ftEV-15W COVER SHEE $$,044.00
I
i II
nevaa�ae�c+�sao� �
SCHEDULEJ
`�""'"'�'`"�"""°`°�'"�'""""'" gENEFICIARIES continued
MHERITpNCE TAX REf11RN
RESIDEM OECEfSENr
ESTA7E OF FILE NUMBER
Hartman,Solita l.
21 -12-01212
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($nyj
��RECEIUlNG PROPER't"Y' oo r�at uat Tru�a{s}
I. TAXABLEDIS7RiBUTiONS(ixiudeafilgMspoueai
disMbutia�# and transfers
under Sec.�N6(a)(i 2)�
4 Kapina N.C3lerdina Granddaughter 10.40d.Od
391 Meirose Street
Schenectady, NY 12306
5 Keith Neijsttbm 6randson 5,000.00
209 Southvi�w Road
Syracuse, NY 132D9
8 Kenneth Neijstrom Grandson 10,000.00
Unft 8600 Box 1236 DPO
AP 9&515
7 Kevin Neijstnom Grandson 10,000.00
316 Commanwealth Avenue
Gortcord,M1A U1742
8 Kerry Neijstrom Marl Granddaughter 10A�OA0
1108 Hayes'Street,#1
Aberdeen,{fUA 88520
9 Karen Neijsttom Granddaughter 14,040.�
118 BoulderRaad
Snlvey, NY 13209
1 d Mary EIIen quaries Goddaughter 5,000.00
403 Byrne Street
Houston, TX 77009
11 Jeffrey Hartman Grendson 10,OOO.QO
P.O. Box 17119
Snowmass�Ilage,CO 81815
12 Trust for Sister Sharon (Judith) Hartman Daughter Thirty-three and
Gary G. Hathnan,Trustee one-third per cent
P.O. Bax 17t10
Snowmass�iilage,C4 81615
13 Trust for Joah NeijsU�om D�ughter Fifty per cent
Garyr G.Harttnan,Trustee
P.p. Box 171',10
Snowmass V�Ilage,Cp 876t5
Page 2 of Schedufe J
_ _
_ , _
REV-0S13EX+(9.pp) �
SCHEDULEJ
COMMONWRAN E�AXREfURNAN�A BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman, Solita L.
21 - 12-01212
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME✓�ND ADDRESS OF PERSON(S) DECEDENT (Wwds) ($$y)
'��RECEIVING PROPERTY ooxauc�r�usuKs�
i, TAXABLEDISTRIBUTIONS[includeoulrightspousal
distribution$ and trenafers
under Sec.'�116(a)(t 2)]
14
15
16
17
18
19
20
21
22
Page 3 of Schedule J