HomeMy WebLinkAbout05-07-15 J ' pennsylvania 1505618403
DEPARTME OF...T:X(03-14) .
REV-15010 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO Box 280601 INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 15 0162
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01 18 2015 10 07 1932
Decedent's Last Name Suffix Decedent's First Name MI
HARTMAN DONALD C
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return 1:12. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4, Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
7. Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received 11. Non-Probate Transferee Return EJ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
13. Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT.THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GEORGE F DOUGLAS III ESQ 717 249 6333
First Line of Address
354 ALEXANDER SPRING RO
Second Line of Address
City or Post Office State ZIP Code
ry
CARLISLE PA 17015 ,
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.
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Correspondent's email address: gdoug las(a)-sa lzmann hug hes.com
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REGISTEf21OF-,iNlC_LS USE ONLYI r'rl
Irl —,7 r.1 C.1
REGISTER OF WILLS USE ONLY
Z�
DATE FILED MMDDYYYY
DATE FILED STAM�o
Side 1
4, -1 r- r- -1 r"� nen
1505618403 1505618403
1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Hartman, Donald C
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 11377 - 95
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages and Notes Receivable(Schedule D).................................................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 25,741 - 85
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 271119 - 80
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 6 -1860 - 14
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 42 - 08
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 6 -,902 - 22
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 20-,217 - 58
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13. 201217 - 58
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 0 - 00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 11 - 00
17. Amount of Line 14 taxable
at sibling rate X.12 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 0 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIG URE OF PERSO R IBLE FOR FILING RETURN Jimmie C GeorgeTE
rs
7
Acrogss
01 "G" Street, Carlisle, PA 013
S]URE O�PARERdQTHER THAN •EPRESE I)VE George F Douglas, lli ESq. DA
��Z�
ADDRESS
354 Alexander Spring Road, Suite 1, Carlisle, PA
111111111111111111111111111111111111111 IN Side 2
1505618411 1505618411
REV-1500 EX Page 3 File Number 21-15-0162
Decedent's Complete Address:
DECEDENT'S NAME
Hartman, Donald C
STREET ADDRESS
1100 N. Pitt St,Apt 2
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 0,00
Make Check Payable to: REGISTER OF WILLS, AGENT.
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent 172 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1503 EX*(08-12)
SCHEDULE B
Iffpennsylvania STOCKS & BONDS
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman, Donald C 21-15-0162
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 591568108 MetLife Stock-27 shares-account#C0022585487 1,377.95
TOTAL(Also enter on Line 2, Recapitulation) 1,377.95
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.08-12)
WARIJING MULTIPLESAFETYFEATURES;THEFACE OF,THIS CHECK NASA BLUE BACKGROUNDAND FLUORESCENT INK(HOLO UNDER 13LACKLIGKT TO,VIEV4:REFER•TO SECURITY ENDORSEMENTBACKERFOR TRUE WATERMARKANDADORIONAL_FEATURES.
MeftiThe� Bank of New York Mellon 60.160
Pittsburgh,Pennsylvania 433
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u'0000 29 ?99 L1 i:0L. 3 30 160 11: 13 L,11 19 3'2u'
r
Rev-1508 EX+(08-12)
SCHEDULE E
Iff, pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman, Donald C 21-15-0162
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M&T Bank Checking Account#1196049-date of death balance 25,672.75
2 Comcast-refund 69.10
TOTAL(Also enter on Line 5, Recapitulation) 25,741.85
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
® M&T Bank
499 Mitchell Road,Millsboro,DE 19966 Records Management
Phone 888-5024349
Fax (302)934-2955
March 31,2015
SALZMANN HUGHES PC
ATTORNEYS AT LAW
79 ST PAUL DRIVE
CHAMBERSBURG PA 17201
Re: Estate of: DONALD C HARTMAN
Social Security:
Date of Death: January 18, 2015
Dear Sir or Madam:
Per your inquiry on March 16, 2015,please be advised that at the time of death, the above-named
decedent had on deposit this bank the following:
1. Type of Account Checking Account
Account Number 1196049
Ownership(Names of) JIMMIE C GEORGE(POA)
DONALD C HARTMAN
Opening Date 01/31/94
Balance on Date of Death $25672.75
Accrued Interest $ 0.00
_....... _.... _.__............_..._._............
....._.
Total $25672.75
For any additional information on the above accounts, including ownership and any changes,
closures and/or reimbursement of funds, please call the Spring Garden Branch at 717-240-4525.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been listed as Power of
Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written
Agreement.
Sincerely,
Terry Elliott
Records Management
REV-1511 EX+(08-13)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERRESIDENT
EDENAX TURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman, Donald C 21-15-0162
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 1,942.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Jimmie C. George
Street Address 162 H Street
city Carlisle State PA zip 17013
Year(s)Commission Paid 2015 Waived
2. Attorney's Fees Salzmann Hughes, P.C. 2,200.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 250.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 2,468.14
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 6,860.14
Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hartman, Donald C 21-15-0162
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exl2enses
1 Ewing Brothers Funeral Home, Inc. -funeral expenses 1,942.00
H-A 1,942.00
Other Administrative Costs
2 Rent-February and March payments so that clean out and refurbishment of apartment could 1,050.00
be completed
3 Sherwin Williams-paint and painting supplies to paint decedent's apartment so that it could 452.05
be rented
4 Tawnya Black-clean out of decedent's apartment, painting and cleaning supplies 786.17
5 The Sentinel -Legal -legal advertising 179.92
H-137 2,468.14
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE1 .
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OFMORTGAGE LIABILITIES AND LIENS
RET
INHERITANCE TAXAXRETURRNN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman, Donald C 21-15-0162
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Bank of America -credit card debt 35.30
2 PPL-electric service 6.78
TOTAL(Also enter on Line 10, Recapitulation) 42.08
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01.10)
pennsylvania SCHEDULE J
!a" DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hartman, Donald C 21-15-0162
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
0 Not List T stee s
ITAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Boiling Springs Bubbler Foundation 20,217.58
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 20,217.58
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
OF CU
No. 2015- 00162 PA No. 21- 15- 0162
J? Estate Of: DONALD C HARTMAN
C Z (First,Middle,Last)
� v
Late Of: CARLISLE BOROUGH
CUMBERLAND COUNTY
r
Deceased
1750 Social Security No:
WHEREAS, on the 13th day of March 2015 an instrument dated
March 13th 2012 was admitted to probate as the last will of
DONALD C HARTMAN
(First,Middle,Last)
late of CARLISLE BOROUGH, CUMBERLAND County,
who died on the 18th day of January 2015 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, LISA M. GRAYSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
JIMMIE C GEORGE
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 13th day of March 2015.
egis er of is
"6j
dui
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
FILE
LAST WILL AND TESTAMENT
I, DONALD C. HARTMAN, of Carlisle, Cumberland County, Pennsylvania, being of
sound mind, disposing memory and full legal age, do hereby make, publish and dearee this toID '
�;1rn
my Last Will and Testament, hereby revoking all Wills and Codicils heretofore Me[& �r}e. a
.� F-
C ) 4i r`7
ONE. I donate my body for scientific purposes to the Humanity Gifts;Registr�of
the Commonwealth of Pennsylvania whose contact number is 215-922-4440 or 215-925-7A69. ''
In order for my donation to be effective, I request that my body not be embalmed or autSoieds, c
-Q
after my death.
TWO. I direct my Executor or Executrix, as the case may be, to pay all of my
debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore,
I direct that all state, inheritance, succession and other death taxes imposed or payable by reason
of my death and interest and penalties thereon with respect to all property composing of my gross
estate for death tax purposes, whether or not such property passes under this Will, shall be paid
by the Executor or Executrix of my estate. Further, to the extent that sufficient assets exist in my
estate, any and all inheritance or other estate taxes, whether to non-charitable or charitable
beneficiaries, shall be paid by my Executor or Executrix from the residuary of my estate prior to
distribution and no part of the taxes paid shall be prorated or apportioned among the persons or
beneficiaries receiving the taxable property regardless of tax rate applicable by law to each such
persons or beneficiaries.
THREE. My Executor or Executrix may, at his or her discretion, compromise
claims, borrow money, retain property for such length of time as he or she may deem proper;
lease and sell property for such prices, on such terms, at public or private sales, as he or she may
01436
deem proper; and invest estate property and income without restriction to legal investments
unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell
any realty and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale
therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and
empowered to engage in any business in which I may be engaged at my death, for such period of
time after my death as seems expedient to said Executor or Executrix.
FOUR- I give, devise and bequeath all of my estate of whatever nature and
wherever situate to the BOILING SPRINGS BUBBLER FOUNDATION, c/o South Middleton
School District, Boiling Springs, Cumberland County, Pennsyvlania.
FIVE. I hereby nominate and appoint JE\4MIE C. GEORGE, to be the Executor
of this my Last Will and Testament.
SIX. No person(s) shall benefit hereunder unless such beneficiary shall survive
me by sixty(60) days.
SEVEN. No Executrix or Executor acting hereunder shall be required to post bond
or enter security in this or any other jurisdiction.
EIGHT. No beneficiary may assign, anticipate or pledge his or her interest in any
income or principal held or distributable hereunder, and no beneficiary's creditors may levy,
attach or otherwise reach any such interest.
NINE. If any person or institution entitled to share in any distribution.under the
terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest
the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its
2
entire interest inherited hereunder and all provisions in favor of such person or institution shall
be declared void and of no effect. The share of such person or institution so forfeited shall be
distributed as part of the residue hereof except that if such person or institution is entitled to
share in the said residue, that interest shall be distributed proportionately to the other residuary
distributees,
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of
2012.
(SEAL)
DONALD C. HARTMAN
Signed, scaled, published and declared by the above-named person as and for a Last Will
and Testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
C)
3
ACKNOWLEDGMENT AND AFFIDAVIT
WE, DONALD C. HARTMAN, GEORGE F. DOUGLAS, 111, and
4'-rt'4 lei czx'KL I the testator and witnesses respectively, whose names are
signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his Last Will, and that he had
signed willingly, and that he executed it as his free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the
Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen
years of age or older, of sound mind and under no constraint or undue influence.
DONALD C. HARTMAN
GEORGE F. DOtGLAS, III
WITNESS
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by DONALD C. HARTMAN, the
testator herein and subscribed and sworn to before me by GEORGE F. DOUGLAS, III and
0(116-d 0 witnesses, this 13 day of 12)LLIFI-) 2012.
Nota/ry Publi0
COMMONWEALTH OF PCENNSYLVANIA
Notarial Seal
Kandy L.Coyle,Notary Public
South Middleton,Twp.,Cumberland County
My Commission Expires July 6,2014
Membe,Pennsvivania Association of Nlotarles
4