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REV-1500
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
FILE NUMBER
d-.-I_ - 12 2"
COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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NUMBER
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SOCIAL SECURITY NUMBER
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DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
l8l1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death aller 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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N E -r- : COMPLETE MAILING ADDRESS
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FIRM NAME (If ApplICable)
TELEPHONE NUMBER 7 /
/7~ 77<1-iP 0
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1) AI/A
(2) A) 711
(3) 'AI /rJ
(4) Njl'i
(5) I~ 7 9~,;(6'
(6) './ 119
(7) AI/A
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
. (Schedule E)
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6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non,Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(9)~ q3~~-V
(10) . 0 I ,'7~
(8) /1. 794f.;L~./
,
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11) I~ 937,df
(12) ~
(13)
(14) &:
x .0_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19) ~
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STR ET A ORE
CITY -r e-e-/1PAJ
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
fl.
(1 )
Total Credits ( A + B + C ) (2)
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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. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
ZIP I '7 I /
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
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For dates of death ~~ -
[72 PS. 99116 (a)
DATE
DATE
/
, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
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The tax rate imposed <..-/' _. .~, ,,"" use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposea on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. 99116(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.
For dates of death
The statute does n
the surviving spous,
)osed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)J.
)m tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
For dates of death c
The tax rate impose
or a stepparent of th,
:ed child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
R.EV.1511 EX+ (12-99~. .
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
EST~T~ OF
,tlfle7/>>!J1V I E lJ iJJlIPd
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G
FILE NUMBER
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
FuAJuc.Al r1-tJmL
j-kAJ;STlI";-e/
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J I r, 4j7. 0 0
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B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2.
Attorney Fees
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3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees
if.
5.
b JI'- (j 0
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5.
Accountant's Fees
6.
Tax Return Preparer's Fees
b.
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7.
TOTAL (Also enter on line 9, Recapitulation) $ / ~ 9 t:1 b _ 6-f)
(If more space IS needed, tnsert additional sheets of the same size)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~t-rmh)/ 'J;lJu)IJeJ G
FilE NUMBER
Include unreimbursed medical expenses,
ITEM
NUMBER
1.
DESCRIPTION
CornrnU AJlltf '--/ €" T.R./JiVI - Ij(.litflo/b~/~n &,/'Ilh.
NU~S lA/I /k",...e.
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PIL c.dJU'~':' (nl.-d'{i.I1/te1N '3
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AMOUNT
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J 71.;'1
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3,
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$~OIO. 71
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lllaaf 2i'Hl nn~ 'Q}tafctmtnt
OF
EDWARD G. HARTIIAH
I, EDWARD G. HARTMAN, of the Borough of Mechanicsburg,
County of Cumberland and state of pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and
making void any and all prior wills by me at any time heretofore
made.
1-
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same may be conveniently
done.
2.
I direct that my entire estate, of whatsoever nature and
wheresoever the same may be situate, be converted into cash, and
for this purpose I authorize and empower my personal
representative hereinafter named to sell any and all real estate
which I may own at the time of my decease, as well as my personal
property, at either public or private sale or sales. After my
estate has thus been converted into cash, and upon payment of all
- 1 -
.
my obligations, the costs of administration of my estate, and all
inheritance and succession taxes, I direct my personal
representative to divide the entire balance of my estate then
remaining into three (3) equal shares, and to payout and
distribute the same in the following manner, to wit:
(a) I give and bequeath one (1) such equal share
to my good friend, ELIZABETH A. BYRD;
(b) I give and bequeath one (1) such equal share
to CAROL A. HEISEY, who is the daughter of Elizabeth A.
Byrd; and;
(c) I give and bequeath one (1) such equal share
to TRACY L. HEISEY, who is the granddaughter of
Elizabeth A. Byrd.
3.
LASTLY, I nominate, constitute and appoint my good friend,
ELIZABETH A. BYRD, Executrix of this my Last Will and Testament,
and in the event that she should predecease me, or should she be
unable or unwilling to serve in such capacity for any reason,
then in such event, I nominate, constitute and appoint her
daughter, CAROL A. HEISEY, Executrix of this my Last Will and
Testament, in her place and stead, and in either instance, I
direct that my said personal representatives be excused from
posting any bond or other security for the faithful performance
- 2 -
..
of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this
II
day of March, A. D. 1997.
~ ---Pt.~ (SEAL)
Edward G. Hartman
Signed, sealed, published and declared by the above named,
EDWARD G. HARTMAN, as and for his Last will and Testament, in the
presence of us, who, at his request and in his presence, and in
the presence of each other, have hereunto subscribed our names
as witnesses.
_ ' ~J4""-'--:2 ;./ " l
- 3 -
.
COMMONWEALTH OF PENNSYLVANIA)
.
.
SS.
COUNTY
OF
CUMBERLAND)
I, EDWARD G. HARTMAN, the testator whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I
signed it willingly; and that I signed it as my free and
voluntary act and deed, for the purposes therein contained.
Sworn and affirmed to and acknowledged before me by EDWARD
G. HARTMAN, the testator, this //;' day of March, 1997.
I
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Notary/public
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SSe
Notarial Seal
~KayEakin, ~ At);,;
~ec;ro.qumbe('<:~d~_,;y
..., ExpresNov.6, L"I. ~
of Noiar--;es
COMMONWEALTH OF PENNSYLVANIA)
COUNTY
OF
CUMBERLAND)
We, the undersigned, J. ROBERT STAUFFER and SUSAN A. McCOY,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and
say that we were present and saw the testator, EDWARD G. HARTMAN,
sign and execute the instrument as his Last will and Testament;
that the said testator, EDWARD G. HARTMAN, executed it as his free
and voluntary act for the purposes therein expressed; that each
of us, in the hearing and sight of the testator, signed the Will
as witnesses; and that to the best of our knowledge, the testator
was, at the time, eighteen (18) or ore years of age, of sound
mind, and under no constraint, res 0 ndue influence.
K,(,
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Sworn and subscribed to before
...
me this i day of!o!arch, 1997.
; / , ' ,/' ) (" .1.
Notary Public
NatalfaI5eaI
MallynKa'i Eakin,:.~~~mIu
Mect~Boro,VYlI-'-""'" ...........J
~CYl.IIfiSSlon~tbI. 6.1997
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Phone: 766-9673
. .
J.ROBERTSTAUFFER
A TTORNEY A T LA W
Market Square Building
Mechanicsburg, Pa, 17055
:.:arcn 11, 1997
To Edward G. rrart~an
T~ ~:r:?i-:i':1g Last trill and Testansnt or :3:dward
Hartn13.n.
To notary ?ublic - ta1{ing ac:-{nm'11edg-",:ent and
vits to Vall.
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