HomeMy WebLinkAbout02-20-08
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15056 51047
REV-1500 EX (06-05)
PA Department of Revenue .
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANC TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
(J (; 7
File Number
o '5 _5 ~
Date of Birth
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Decedent's Last Name Suffix
Decedent's First Name
MI
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EH\Li
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(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN UST BE FILED IN DUPLICATE WITH THE
R GISTER OF WILLS
FIILL IN APPROPRIATE OVALS BELOW
c:> 1, Original Return
c:>
2, Supplemental Return
c:>
3, Remainder Return (date of death
prior to 12-13-82)
5, Federal Estate Tax Return Required
c:>
c:> 4a, Future Interest Compromise (date of
death after 12-12-82)
7, Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:> 10, Spousal Poverty Credit (date of death c:> 11, Election to tax under Sec, 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch, 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6, Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
c:>
8, Total Number of Safe Deposit Boxes
c:>
4, Limited Estate
c:>
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1 \ '1 Lt CI 1 '1 00 b L
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
First line of address
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RVN
DKI\Jt
Second line of address
APT
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City or Post Office
State
ZIP Code
DATE FILED
(AM?
it,LL
PA
170
Correspondent's e-mail address:
(","-co, cOY\
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,
2, li)'(' Lv'l'-" LvV', Dv'",<.. C(,V>'~ P ~\ I \
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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DATE
I',DDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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15056052048
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
11B \ 4 2-\blo
RECAPITULATION
1. Real estate (Schedule A).
1.
2. Stocks and Bonds (Schedule B) . . . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3.
4. Mortgages & Notes Receivable (Schedule D). .
4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . 5.
6 Jointly Owned Property (Schedule F) c:::> Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.. . . . . 7.
8. Total Gross Assets (total Lines 1-7).
8.
.
.
.
.
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.
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.
.
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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) ... ..........
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . .
. . . 12.
. . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15 Amount of Line 14 taxable
at the spollsal tax rate. or
transfers under Sec. 9116
(a)(1.2) XO_ +
. . . . 14
15.
16. Amount of Line 14 taxable
at lineal rate X.O ~
17. Amount of Line 14 taxable
at sibling rate X. 12
18. Amount of Line 14 taxable
at collateral rate X .15
5toBt1
,
16.
17.
;
18.
19 TAX DUE
. . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
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15056052048
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15056052048
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REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
STREET ADDRESS
C:Ki L'I ~El\~~E- \-\EW~i-
GSl ~e\LI;'e..E-~__C~~~_,=~E_____~__~________________
CITY
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Tax Payments and Credits:
1. Tax DUE' (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
ZIP
11 a.~('l
co b B. '1l
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
CObb. I \
A. Enter the interest on the tax due.
(5)
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
5~b.'7 \
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:
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 occurred after December 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? .........
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .....................................................................................................................
Yes
.............0
o
...0
o
...........0
....0
..0
No
o
o
o
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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.
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. 39116 (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 PS. 39116 (a) (1.1) (ii)] The statute does not exemot 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 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 [72 P.S. 39116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 39116(1.2) [72 P.S. 39116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent[72 P.S. 39116(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.
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illctnt mill Nnb [Lcntctm~nt
of
EMILY JEANNE HENRY
BE IT REMEMBERED, that I, EMILY JEANNE HENRY of 657 Revere Circle,
Lewisberry, Pennsylvania 17339, being of sound mind, memory and
understanding, do make, publish and declare this as and for my Last Will
and Testament, hereby revoking and making null and void any and all
Wills and Testaments and writings in the nature thereof by me, at
anytime heretofore made.
ITEM 1. BURIAL INSTRUCTIONS:
I direct that no autopsy be performed on my body. I further direct
that I be cremated by a reputable firm and that my ashes be placed next
to my husband, BOYD M. HENRY, at the Grandview Cemetery, Johnstown, Pa.
I last direct that prayers be said for me.
ITEM 2. DEBTS AND FUNERAL EXPENSES:
I direct that all my just debts and funeral expenses be paid as soon
after my demise as may be convenient.
ITEM 3. TANGIBLE PERSONAL PROPERTY:
I give and bequeath all tangible personal property owned by me at my
death and all insurance policies on such property as follows:
Ct. To those individuals who survive me and who are designated on a
list or memorandum signed by me which refers to this Will or is
found with a copy th~reof, I give and bequeath the items listed
beside their names.
b. The balance (including any items under subparagraph (a) above
the bequest of which has lapsed) shall be included in my
residuary estate, and shall by distribution by my hereafter
named Personal Representative to the beneficiaries thereof as
herein provided. My Personal Representative shall have the
WITNESS:
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(SEAL)
E HENRY
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right to dispose of said remaining items of personalty to become
part of my residuary estatet either in kind or in cas~ as ,a
result of liquidation thereof as my Personal Representatlvet In
my Personal Representativets sole discretiont deems appropriate
under the circumstances. It is my intentt howevert that should
any beneficiary of my residuary estate desire to receive a
particular item in kind which was not specifically bequeathed to
that beneficiarYt to the extent reasonably possiblet my Personal
Representative shall attemptt but not be obligatedt to follow
that beneficiary's request.
c. If any beneficiary of any item of tangible personal property
aforesaid has not yet attained the age of 18 at the time of my
deatht I order and direct that my Personal Representativet
hereinafter namedt to hold said items in safekeeping for that
beneficiary and to deliver the same to that beneficiary upon he
or she reaching age 18. For these purposes my Personal
Representative shall be entitled to use or set aside from my
estate sufficient funds to provide for that safekeeping.
ITEM 4. SPECIAL BEQUEST:
I give and bequeath my two New York Life Insurance Annuity Corporation
annuity policiest designated as Policy No. 58089722 and Policy No.
58089368t or the proceeds to be payable thereundert unto my Co-Trusteest
FRANCES KRING and FREDERICK C. RAFFETTO t (hereafter appointed and
referred to as ~Trustee") t to be held for the benefit of my
grandchildren, JOSHUA A. PIRO and JUSTIN S. PIROt IN TWO SEPARATE AND
EQUAL TRUSTS, under and subject to the following terms and conditions:
a. Trustee may accumulate the income from each beneficiaryts trust
or so much thereof from time to time as they considers
advisable; and Trustee may expend and apply so much of the net
income including accumulated income and so much of the principal
of that share as Trustee may consider necessary for the support,
maintenance, medical and dental expenses and education of that
beneficiary, including college educationt both graduate and
undergraduate, or post-secondary vocational or technical
trainingt in accordance with that beneficiary's talents,
abilities and needs; and Trustee may pay all expenses which it
deems necessary and desirable in connection therewith,
includingt by way of illustrationt room and board, clothingt
travel expenses, tuitiont books and suppliest and reasonable
sums for personal and living expenses. The amount to be paid
WITNESS:
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for the benefit of that beneficiary shall be determined from
time to time based on that beneficiary's needs, considering that
beneficiary I s other income and assets, including any income
payable for the benefit of that beneficiary from other sources
as other trusts or social security or other governmental
benefits, with the further direction that the funds shall be
liberally disbursed. The said payments may be made as my
Trustee deems appropriate directly to that beneficiary if that
beneficiary is, in the sole opinion of my Trustee, of an age and
ability to handle the funds so paid; or directly to the person
having custody and care of that beneficiary; or directly to any
institution entitled to such paYment by reason of services
rendered or to be rendered to that beneficiary:
b.
The Trustee
stated above
other powers
for the purposes of carrying out my intentions
shall have the following powers, in addition to all
granted by law or other provisions of this Will:
1. To retain any property, real, personal or mixed, and to
manage the same for the benefit of this Trust;
2.
To sell at public or private
period of time, any real or
prices and upon such terms
appropriate;
sale, or to lease for any
personal property for such
and conditions as may be
3. To compromise any claim or controversy and to abandon any
property which is of inconsequential value;
4. To make distribution to my herein-named beneficiaries, on
their behalf, in cash or in kind; and
5. To carryon any business owned or controlled by me at my
death, for whatever period of time is deemed proper, and to
do all things necessary and appropriate to manage,
supervise and operate the business and to close out,
liquidate or sell the business at such time and upon such
terms as are deemed proper.
c. Trustee shall invest all trust funds received by my Trustee
including, but not limited to, income received from the
retention of property in kind and cash received from the
liquidation and sale of property, in any minimal risk
investments including, but not limited to: checking accounts,
savings accounts, money market accounts, certificates of
deposit, mutual fund accounts or other minimal risk investments
,
or any combination thereof. Distribution from the Trust shall
be made solely for the benefit of the beneficiary of the Trust
in accordance with my instructions set forth in subparagraph
(a); provided, however, that my Trustee shall be entitled to pay
VHTNESS:
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for any taxes, professional services or other fees arising out
of the administration of the -Trust and shall be entitled to
periodic, reasonable compensation for services rendered
hereunder, which may be equitably apportioned between principal
and income.
d. Any and all paYment or payments of any sum or sums, whether in
cash or in kind or whether for principal or income, payable to
the beneficiary, shall be made upon the sole receipt of the
respective individual to whom the payment is made, free from
anticipation, alienation, assignment, attachment, and pledge,
free from control by the creditors of any such beneficiary and
shall not be subject to any execution or attachment.
e. When each beneficiary reaches age thirty (30), the then
remaining assets, principal and any accumulated or undistributed
income of that beneficiary's Trust shall be distributed to that
beneficiary, absolutely.
f. In the event a beneficiary hereunder dies before reaching age
thirty (30) the remaining principal and any accumulated income
of his Trust shall be distributed at his or her death to the
other beneficiary set forth in this item, or in the event the
other beneficiary is not then living I that share shall be
distributed to my then living residuary beneficiaries set forth
in Item as set forth 5 or in the event of lapse, Item 6 herein,
in the proportions provided for therein.
g. Should the principal of the Trust herein provided for be or
become too small in the Trustee r s discretion so as to make
establishment or continuance of the trust inadvisable, my
Trustee or Personal Representative may make immediate
distribution of the then-remaining assets, principal and any
accumulated or undistributed income outright to the Guardian of
the Person of any minor beneficiary herein appointed or to the
person or persons and in the proportions they are entitled.
ITEM 5. RESIDUARY ESTATE:
All the rest, residue and remainder of my Estate of whatsoever nature
and wheresoever situate, whether it be real, personal or mixed,
including any insurance policies therefor, property over which I have
power of appointment, and proceeds from any insurance policies payable
to my estate, I give, devise and bequeath to my children, FRANCES KRING,
HENRY M. BOYD, JR. And PATRICIA J. PIRO, in equal shares per capita.
WITNESS:
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ITEM 6. ALTERNATE RESIDUARY ESTATE:
In the event all of my children, FRANCES KRING, BOYD M. HENRY, JR. And
PATRICIA J. PIRO, have failed to survive me, I then give, devise and
bequeath my entire residuary estate to the issue of my children, FRANCES
KRING, BOYD M. HENRY, JR. and PATRICIA J. PIRO, in equal shares, per
capita.
ITEM 7. APPOINTMENT OF TRUSTEE:
I appoint FRANCES KRING and FREDERICK C. RAFFETTO, or the survivor of
them, as Trustee of any Trust created by this my Last Will and
Testament.
ITEM 8. APPOINTMENT OF GUARDIAN OF PROPERTY:
I appoint FRANCES KRING and FREDERICK C. RAFFETTO as Guardian over any
property which passes either under this Will or otherwise to any
beneficiary who is then a minor.
ITEM 9. APPOINTMENT OF PERSONAL REPRESENTATIVE:
I appoint FRANCES KRING as my Personal Representative of this my Last
Will and Testament.
Should FRANCES KRING
predecease me, fail to
qualify, cease to act or renounce probate, I then appoint BOYD M. HENRY,
JR. as Alternate Personal Representative of this my Last Will and
Testament.
ITEM 10. PAYMENT OF TAXES:
I direct my Personal Representative to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature and kind, to which my
Estate or the transfer of any property passing hereunder or otherwise
passing by reason of my demise, may be subject and to charge such taxes
WITNESS:
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agrainst my residuary estate, it being my intention that none of the
aforesaid taxes, either federal or state, or any property required to be
included in my gross estate, under the provisions of any state or
federal law now in force or hereafter enacted, shall be prorated among
the persons interest in my Estate to whom such property is or may be
transferred to whom any benefit accrues.
ITEM 11. POWERS OF PERSONAL REPRESENTATIVE:
In addition to the powers conferred by law, I authorize my Personal
Representative in my Personal Representative's absolute discretion:
a. To retain in the form receive, and to sell either at public or
private sale any real or personal property;
b. To mapage real estate;
c.
To invest
confined
principle
and reinvest in all forms of property without being
to legal investments, and without regard to the
of diversification;
d. To exercise any option or rights arising from ownership of
investments;
e. To compromise claims without court approval and without the
consent of any beneficiary;
f. To disclaim any interest in property;
g. To claim an elective share of the estate of any deceased spouse;
h. To join with any spouse I may have upon my death in the filing
of any federal income tax return for any year for which I have
not filed such return prior to my death, and to consent to the
treatment of any gifts made by my spouse as being made one-half
by me for gift tax purposes notwithstanding the fact that such
action may result in additional liabilities for my estate. Any
income or gift taxes due on such returns and any deficiencies,
interest, penal ties, or refunds thereon, shall be allocated
between my estate and my spouse and my spouse's estate, or all
to any of them, in such manner as my Personal Representative and
my said spouse may agree.
IWITNESS:
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i.
To disburse my estate in kind or by way of liquidation thereof
in whole or in part as my Persortal Representative in my Personal
Representative's sole discretion may deem appropriate under the
circumstances.
ITEM 12. NO BONDING REQUIREMENT:
I direct that my Personal Representative, Guardian and Trustee or
their successors shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
ITEM 13. SURVIVAL:
Any person or organization herein named or referred to shall be deemed
to have survived me only of such person or organization shall in fact
survive me for a period of at least thirty (30) days.
Any person or
organization named or referred to herein who shall not survive me by a
period of thirty (30) days shall be deemed to have died before I do.
ITEM 14. GENDER AND NUMBER:
Where appropriate to the context, pronouns or other terms expressed
in one number or gender shall be deemed to include the other number or
gender, as the case may be.
ITEM 15. EXCLUSION:
It is not my intention to make provision in this, my Last Will and
Testament, for any relative or any other person not expressly provided
for herein, except for children born to or legally adopted by me after
the date of this instrument, and if any such person has not been
expressly mentioned herein, he or she has been omitted by me
intentionally dnd with full knowledge of his or her relationship and
existence, and not by any oversight or neglect.
WITNESS:
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~1\--day
of, J~--...J-
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ACKNOWLEDGMENT
CC)MMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, EMILY- JEANNE HENRY,
~rJe" ~. ~LVN2EZ..
and Diane
G. Radcliff, Esquire, the TESTATRIX and 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 TESTATRIX signed and executed the instrument as Last will and that
TESTATRIX had signed willingly (or willingly directed another to sign
for the TESTATRIX, and that TESTATRIX executed it as TESTATRIX free and
voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the TESTATRIX, signed the Will
as witnesses -and that to the best of their knowledge the TESTATRIX was
at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed to
before me this
f:tL
day
, 19C]L.
k~of!~~
NOTARY PUBLIC
My Commission Expires:
Notarial Seal
Deborah L. Donley, Notary Public
Camp HI!' ~oro, Cumberland County
My CommIssIon Expires Sept. 23,1999
Mfllnbflr Pennsvl".ulla A~socla!i(111 III Not~rios"'
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