HomeMy WebLinkAbout05-14-07
15056041147
REV~'1 goo EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County code veer File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.2aosol RESIDENT DECEDENT 21 0 7 0 2 6 4
Harrisburg, PA 1712&0601
ENTER DECEDENT INFORMATION BELOW Date of Birth
Social Security Number Date of Death
186249257 03232006
Suffix Decedent's First Name MI
Decedent's Last Name
WILLIAM J
HENRY
(If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name
Spouse's Last Name
MI
Spouse's Socal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW ~ 3, Remainder Retum (date of death
tum
l R
t
X^ 1. Original Retum e
a
~ 2. Supplemen
pnor to 12-13-82)
t ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required
e
4. Limited Esta (date of d~ttr after 12-12-82)
8 Decedent Died Testate
W
l 7. Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes
~ (Attach Copy d Trust)
i
p
(Attach Copy of
eived
R
d ~ 10. Spousal P°veerrttyv Credit ((date of death ~ 11. Election to tax under Sec. 9113(A)
t-95)
O)
d i
h Sch
~9t
Att
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s
9. Litigation Procee .
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between t2-st
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BE DIRECTED TO:
IS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTI
b
CORRESPONDENT -TH
me
N er
Daytime Telephone N m
a 7172436222
GEORGE F. DOUGLAS III
Firm Name (If Applicable) ~~~
REGISTER OF WILLS USE ~N,ILY
-
SAIDIS, FLOWER & .
- _ J ~{
LINDSAY ~
-
First line of address .
- _- .._,
~ '_'
~~
26 WEST HIGH STREET _' ~- - _~'
,__
_,
Second line of address _
~ : -; ;
-
{_-~
~
DATEFiILED `. ~ r-r
City or Post Office _
State ZIP Code --' . -- i
-..,
CARLISLE
P A 17 013
Correspondent's e-mail address:
It is tertrie^roalr e t and~roump le e~Dr~ahration of pre~parer otFier tttan he np~ersonalarepresentarhve Ss based on aU In~fortna It on~of whc h preparerfhas any kndowledge.~lief,
DATE
Patricia
26 Cambrid a Ct., Carlisle, PA 17013 DATE
SIG TORE OF PREPARER OTHER THAN REPRESENTATIVE ,20 O
~~e ~~~~~ ~ George F. Douglas 111 ~-y- ~ ~
ADDRESS
26 West High Street, Carlisle, PA 17013
Side 1
15056041147 15056041147
. ~,,.
REV-1500 EX
15056042148
oee~enes r~art,e: W i I l i a m J H e n ry
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
2.
2. Stocks and Bonds (Schedule B) ...............................................................................
3. Closely Held Corporation, Partnership or Sole-Proprie~rship (Schedule C).......... 3.
.......................................................... 4.
4. Mortgages & Notes Receivable (Schedule D
5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) ................ 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vvos Transfers & Miscellaneous Non-P$ep ~~ Billing Requested ............. 7.
(Schedule G) ^
8. Total Gross Assets (total Lines 1-7) ....................................................................... 8.
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) ...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12.
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13.
id_ Net Value Subiect to Tax (Line 12 minus Line 13) ................................................. 14.
Decedents Social Security Number
186249257
12,019.21
12,019.21
0.00
12,019.21
12,019.21
0.00
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable 0 . 0 0 16
at lineal rate X .045 .
17. Amount of Line 14 taxable 0 . 0 0 17
at sibling rate X .12 ,
18. Amount of Line 14 taxable 0 , 0 0 18
at collateral rate X .15 .
19. Tax Due ............................... ...................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L, 15056042148 15056042148
0.00
0.00
0.00
0.00
0.00
File Number 21-07-0264
REV~1500 FJC Page 3
Decedent's Complete Address:
DECEDENTS NAME
William J Henry
STREET ADDRESS
26 Cambridge Ct.
STATE ZIP
CITY pA 17013
Carlisle
Tax Payments and Credits: (1) 0.00
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A, Spousal Poverty Credit
g, Prior Payments
C. Discount 0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if appligble
p, Interest
E. Penalty
Total InteresUPenalty (D + E)
(3)
AYMENT.
If Line 2 is greater than Lin
4
' (4)
,
quest a refund
Check box on Page 1 Line 20 tto e 00
0
g, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
.
Enter the interest on the tax due.
A (5A)
.
This is the BALANCE DUE.
f Line 5 + 5A
l
t
t
(58)
~.~~
.
o
o
a
g, Enter the
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
1. Did decedent make a transfer and:
. .........................................
a. retain the use or income of the property transferred :....................................... .. ^
b. retain the right to designate who shall use the property transferred or its income :.................................... ^
c. retain a reversionary interest; or .................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? ..............................................................
2. If death oaxarred after December 12, 1962, 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?......... ^ LJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ~ ^
.............................
contains a benefidary 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 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 zero
(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 disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary.
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 years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent p2 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. §9116 1.2) p2 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent p2 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.
R"~'~°°~`+`~' SCHEDULE E
' CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
cowMOwwEnuN of aENNSVwANw
WHERRANCETAXRETURN
RESDENT DECEDENT
FILE NUMBER
ESTATE OF 21-07-0264
Henry, William J
Indude the proceeds of litigatlon and the date the proceeds were received by the estate.
All properly )oirNYowned with the rlpht of survlvarship must be dbcbsed on schedule F.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
IRA Deferred Annuity #110-EA0000568 -wife beneficiary 12,019.21
1 Life Investors Insurance,
of contract -see letter attached
2 Life Investors Insurance, Policy #100-EG6004589 -life insurance payable to the 0.00
estate -non-taxable
TOTAL (Also enter on Line 5, Recapitulation) I 12,019.21
(If more space is Headed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
-«
Rw•1502 EX+ (~)
coN"aNwEA~rN of PENNSVwANu
NIHERRANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF
Hanrv_ William J
SCHEDULE J-IIA
SPOUSAL DISTRIBUTIONS UNDER
SECTION 9113 FOR WHICH AN
ELECTION TO TAX IS NOT BEING MADE
continued
ITEM DESCRIPTION
NUMBER
Patricia Henry -tax free distribution of IRA to another IRA
LE NUMBER
21-07-0264
AMOUNT
Subtotal
12,019.21
12.019.21
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule JdIA (Rev. 6-98)
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I, WILLIAM J. HENRY, of the Borough of Carlisle,
Cumberland County, Pennsylvania, being of sound and
disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and.
Testament, hereby revoking all other wills and codicils
heretofore made by me.
ARTICLE ONE c'
~_C~
PAYMENT OF DEBTS AND ERPENSES -~ ~ 4
FUNERAL ARRANGI~NTS - r }'.,
I direct the payment of the debts and expenses of ~Y.
last illness from my estate as soon after my death as.
conveniently may be done.
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ARTICLE TWO
DISPOSITION OF PROPERTY
I give, devise and bequeath all of my property, real,
personal and mixed, of what nature or kind so ever, and
wheresoever the same shall be at the time of my death, to
my beloved wife PATRICIA ~'. HENRY, provided she survives me
by thirty (30) days not c~unting the day of my decease.
In the eveat that my beloved wife PATRICIA B. HENRY
predeceases me or fails to survive me by the aforesaid
period, I give, devise and bequeath all of my property,
real, personal and mixed, of what nature or kind so ever,
and wheresoever the same shall be at the time of my death,
to my children and step-children, BRIAN J. BEITTEL, BENICIA
B. MEYERS, KRISTA L. RAT+'.R, WILLIAM S. HENRY, AND ANDREW J•
HENRY, share and share alike. If any of the above children
or stepchildren fail to survive me by thirty (30) days not
counting the .day of my decease, I give, devise and bequeath
the share of the deceased child or step-child to be given
to the children of the deceased in equal shares.
Furthermore, I direct my Executor to distribute such
specific items that I may specify in a list which I will
attach to this my Last Will and Testament to those above-
named beneficiaries so specified.
`-
'`=ri
-,
. -'-
_ _ ~ .j
In the event that my beloved wife PATRICIA B.
't I ive devise and
.HENRY and I perish in a common calami y, g
:bequeath $75,000.00 to be distributed equally to my
grandchildren, KYLE W. nnr.R, gAITLIN A. BAER, MORGAN R.
HENRY, MATTHEW W. HENRY, RYAN J. HENRY and KRISTEN M.
HENRY. I give, devise and bequeath the rest, residue and
remainder of my estate to my children and step-children,
BRIAN J. BEITTEL, BENICIA B. MEYERS, KRISTA L. BAER,
WILLIAM S. HENRY, AND ANDREW J. HENRY, share and share
alike. If any of the above children or stepchildren fail
survive me by thirty (30) days not counting the day of my
decease, I give, devise and bequeath the share of the
deceased child or step-child to be given to the children
the deceased in equal shares.
to
of
Furthermore, I direct my Executor to distribute such
specific items that I may specify in a list which I will
attach to this my bast Will and Testament to those above-
named beneficiaries so specified.
ARTICLE THREE
TAXES
I direct that any and all inheritance, estate. and
transfer taxes imposed upon property making up my estate
passing under my Will or otherwise, shall be paid out of
the principal of my residuary estate prior to its
distribution to my heirs.
ARTICLE FOUR
EXECUTRIX/RIXES'S POWERS
In addition to the powers and authority conferred by
law or necessary and appropriate for proper administration,
I authorize my Executrix/rixes in her or their absolute
discretion:
1. To retain in the form received, and to sell
either at public or private sale any real or
personal property;
2. To lease, mortgage or otherwise encumber any real
or personal property that may be included in my
estate, without order of court or notice to any
beneficiary;
3. To invest and reinvest in all forms of property;
4. To exercise any options or rights arising from
ownership of investments; and
5. To compromise claims without court approval and
without the consent of any beneficiary.
2
ARTICLE FIVE
NOMINATION OF EXECUTOR/EXECUTRIX
I hereby nominate, constitute and appoint my wife,
PATRICIA B. HENRY to serve as Executrix, if living and able
to serve as same. If my wife is deceased or is otherwise
unable to serve as Executrix, I hereby nominate, constitute
and appoint BENICIA B. MEYERS and KRISTA L. RAFR to serve
as Co-Executrixes, if living and able to serve as same. I
hereby relieve my Executrix/rixes from the necessity of
posting security in connection with their duties as such in
any jurisdiction in which they may be called to act insofar
as I am able to do so by law .
ARTICLE SIX
MISCELLANEOUS PROVISIONS
A Paragraph Titles and Gender. The titles given to the
paragraphs of this Will are inserted for reference
purposes only and are not to be considered as forming a
part of this Will in interpreting its provisions. .All
words used in this Will in any gender shall extend to
and include all genders, and any singular words shall
include the plural expression, and vice versa,
specifically including "child" or "children," when the
context or facts so require, and any pronouns shall be
taken to refer to the person or persons intended
regardless of gender or number.
B. Thirty Day Survival Requirement. For the purpose of
determining the appropriate distributions under this
Will, no person shall be deemed to survive me unless
such person is also surviving on the thirtieth day
after the date of my death .
C. Liability of Fiduciary. No fiduciary who is a natural
person shall, in the absence of fraudulent conduct or
bad faith, be liable individually to any beneficiary of
my estate, and my estate shall indemnify such natural
person from all claims or expenses in connection with
or arising out of that fiduciary's good faith actions
or non-actions as the fiduciary, except for such
actions or non-actions which constitute fraudulent
conduct or bad faith.
I1Q,WITNESS WHEREOF, I have subscribed my name below,
this (p y of April, 2004.
Testator Signature
COMMONWEALTH OF PENNSYi,VANIA
Notarial Seal
Kathleen K. Shaulis, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Dec. 22, 2007
3
Member, Pennsylvania Assodation of Notaries
We, the undersigned, hereby certify that .the above
instrument was signed in our sight and presence by WILLIAM
J. HENRY, the Testator, who declared this instrument to be
his Last Will and Testament and we, at the Testator's
request and in the Testator's sight and presence, and in
the sight and presence of each other, do hereby subscribe
our names as witnesses on the da~e shown above.
Witness Signature
Name
City, State
Witness Signature
Name
COMMONWEALTH OF PENNSYLVANIA ity, State
Notarial Seal
Kathleen K. Shautis, Nottaaryry Public
Carlisle Boro, CumberlandCouttiy
My Commission Expires Dec. 22, 2007
Member. Pennsylvania Association of Notaries
VOUP..{'1~ ~- b'S~i I n
AFFIDAVIT
CO1~lONWEALTH OF PENNSYLVANIA
COUNTY OF CUI~ERLAND
I, WILLIAM J. HENRY, 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, that I signed it
willingly and as my free and voluntary act for the purposes
expressed in the instrument. ^ i+ _
Testator Signature
IAM J.
Subscribed, sworn to and
me by~WILLIAM
J. HENRY, the Testator, this lQ~ day of April, 2001
No ry Public
4
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Kathleen K. Shaulis, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Dec. 22, 2007
Member, Pennsylvania Association of Notaries
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COIINTY OF CUMBERLAND
_l rp ~_ f F
We , 1/a l~v-c e' ~ C-~scj 1 , and James ~1~.. ~1 ~Gt't~C I ~S ,
the witnesses, respectively, whose names are signed to the
attached or foregoing instrument, being first duly sworn,
do hereby declare to the undersigned authority that the
Testator WILLIAM J. HENRY signed and executed the
instrument as his Last Will and Testament and that he
signed willingly, and that he executed it as his free and
voluntary act for the purposes therein expressed, and that
each of his witnesses, in the presence and the hearing of
the Testator signed the Last Will and Testament as
witnesses and that to the best of their knowledge the
Testator was at that time eighteen (18) years of age or
older, of sound mind and under no constraint or undue
inf luen~c/e ,/~
WITNESS (, G~ ' residing at yd2w1 fr(/1 ~I ~ / 7(lrJ~
WITNESS ~~1 ` ~ residing at ~.Lt, r~t~~ , ~/~ (-7 61 }
witnesses,
sworn to and acknowledged before me by
and ~C1~v~CS ~. S~Gl Ulf 1 S the
~~ day of April, 2004.
COMMONN1rE,~I,TH OF PENNSI'I.VAMA
Kathleen K. Shaul s, Ndo
Carlisle Boro, Cumberland Cauniy
My Commission Expires Dec, 22, 2007
Member, Pennsylvania Association of Notaries
5
L~ ®LIFE INVESTORS INSURANCE
C O M P A N Y O F A M E R I C A
May 8, 2006
Orrstown Bank
427 Stonehenge Dr
Carlisle PA 17013
~~~
Life Investors Insurance
Company of America
Administration Office:
4333 Edgewood Road NE
Cedar Rapids, Iowa 52499
Re: Patricia B. Henry - spouse beneficiary of William J. Henry
Our IRA Deferred Annuity #110-EA0000568
Your IRA Account # not given
Enclosed is check #01421382 in the amount of $12,019.21 representing
the entire value of the above-listed IRA, as requested.
We have closed this account and updated our records to reflect a tax-
free transfer to another IRA with your bank.
If you have questions, please call me at 319-398-8994. Our company is
available to you weekdays from 7 a.m. to 4:30 p.m. Central Time.
Cordially,
1
Kathy Droneba er
Qualified Plans Department
Life Investors Insurance Company of America
copy: Patricia B. Henry
26 Cambridge Ct
Carlisle PA 17013-2733
file
Member of the `EGON. Group 28853 5/01
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To: InvoiceNo: 1417
Invoice Date: 5/ 15/2007
SAIDIS FLOWER & LINDSAY Estate of: WWilliam ~~'
26 WEST HIGH ST Estate No: 21-07-0264
dm
CARLISLE, PA 17013
Qty Fee Description Fee Total
1 Additional Probate 15.00 $15.00
Total: $15.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
LAW OFFICES
SAIDIS, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
JOHN E. SLIKE CAMP HILL, PENNSYLVANIA 17011 CARLISLE OFFICE:
ROBERT C. SAIDIS TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 26 WEST HIGH STREET
JAMES D. FLOWER 1R EMAIL: attorney®sfl-law.com CARLISLE, PA 17013
CAROL J. LINDSAY www.sfl-law.com TELEPHONE: (717)243-6222
JOHN B. LAMPI FACSIMILE: (717)243-6486
MICHAEL L. SOLOMON
GEORGE F. DOUGLAS, III
DEAN E. REYNOSA REPLY TO CAMP HILL
THOMAS E. FLOWER
MARYLOU MATAS
SUZANNE C. HIXENBAUGH
r._ ,
May 9, 2007 ~~-~ c7 `:
~~
~.: ~ sa~,
Register of Wills _, `.
Cumberland County Courthouse `_' -~ - _~
Carlisle, PA 17013 =, -
Re: The Estate of William J. Henry y ~'~
File No. 21-07-0264
Dear Ladies:
Enclosed is an original and two copies of an Inheritance Tax Return to be filed in regard
to the above estate. Kindly return atime-stamped copy to our office in the envelope provided.
A check is also enclosed for the filing fee. Thank you.
Very truly yours,
SAIDIS, OWER & LINDSAY
Cam- f
She by L. Y' ing, Es a aralegal
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