HomeMy WebLinkAbout03-28-08
-I
15056051058
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes .
PO BOX 280601
Harrisburg, PA 17128-{)601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
9.\ b1
()\O~}
Date of Birth
172-32-0458
06/29/2007
11/03/1940
Decedent's Last Name
Suffix
Decedent's First Name
MI
Headley
Carol
A
(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 MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
. 1. Original Retum
2. Supplemental Retum
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 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
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Nicole L. Snell
(717) 766-3464
Firm Name (If App icable)
. ,
REGISTER Of WII:t;.S USE ONLY~
. ~._J
First line of address
r.....)
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34 W. Keller Street
-,
Second line of address
'\ i
City or Post Office
State
ZIP Code
DATE FILED
N
Mechanicburg
PA
17055
Correspondent's e-mail address:
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.
51 URE Of PERSO NSIB OR FILING RETURN DATE
ADD
~ W. ~.~ ~ I f\,(,~tUioo6o;~ . p~ ,-rO ~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
---.J
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15056052059
REV-1500 EX
Decedent's Name:
RECAPITULATION
Carol
A Headley
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) Separate Billing Requested . . . . . .. 6.
7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 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/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - 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 .0_
16. Amount of Line 14 taxable
at lineal rate X.O 45 60,137.93
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
Decedent's Social Seeurity Number
172-32-0458
0.00
0.00
0.00
0.00
77,993.62
77 ,993.62
17,029.99
825.70
17,855.69
60,137.93
60,137.93
2,706.20
2,706.20
15056052059
.....J
~1502 EX+<6-_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Carol A Headley 21-07-0642
All real property owned solely or as a Itnant in common must be reported at fair market value. Fair marllet value is defined as the price at which property would be
exchanged between a willing buyer and a wiDing seHer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant faels.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
NOT APPLICABLE - NO REAL PROPERTY
VALUE AT DATE
OF DEATH
0.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1503 EX+ (6-98*
COMMONWEAlTH OF PENNSYLVANIA
INiERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Carol A. Headley
FILE NUMBER
21-07-0642
All property jointly~wned with right of survivol'$hip must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
NOT APPLICABLE - NO STOCKS OR BONDS
0.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, illSert additional sheets of the same size)
0.00
~'I~ EX+ (6-98)
..
COMMONWEALTH OF PENNSYlVANIA
INiERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
aOSElY-HElD CORPORATlON,
PARTNERSHIP OR
SOlE-PROPRlETORSHIP
ESTATE OF
Carol A. Headley
FILE NUMBER
21-07-0642
ITEM NUMBER
NUMBER DESCRIPTION
Schedule C-1 or C-2 (including all supporting information) must be atlached for each closely-held corporation/partnership interest of the decedent. other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
VALUE AT DATE
OF DEATH
1. NOT APPLICABLE
0.00
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
0.00
REV-1507 EX+ (6-98)
.. .
COMMONWEALTIi OF PENNSYLVANIA
ItIHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABlE
ESTATE OF
Carol A. Headley
FILE NUMBER
21-07-0642
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
NOT APPLICABLE - NO MORTGAGE OR NOTES RECEIVABLE
VALUE AT DATE
OF DEATH
0.00
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
0.00
~1508 EX+ (6-98)
.. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERlY
ESTATE OF
Carol A. Headley
FILE NUMBER
21-07-0642
ITEM
NUMBER
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
VALUE AT DATE
OF DEATH
1. CASH - FROM LIFE INSURANCE PROCEEDS
68,184.67
61.00
2. REFUND CHECK -PINNACLE HEALTH OVERPAYMENT
3. REFUND CHECK - HERITAGE MEDICAL GROUP OVERPAYMENT
45.34
4. REFUND CHECK - KLP ENTERPRISES SECURITY DEPOSIT REFUND
400.00
5. 401K distribution from William H. Headley(deceased husband)
9,302.61
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
77,993.62
~ .....'_V...........A.L A..'''''L&4.1.J.
08/18/2007
08/16/2007
08/08/2007
j
~ 08/08/2007
08/07/2007
Deposit
To Share 11
I To SNELL,NICOLE L 0000210089 Share 11 !
I To SNELL, NICOLE L 0000210089 Share 11 4-
~S~re11 !
08/07/2007 ! i~ SNELL,TIMOTHY S 0000214862 Share I
I \
08/07/2007 I To SNELL, NICOLE L 0000210089 Share 11 !
07/30/2007 Deposit
07/28/2007 Deposit
~tQ:~", ~
$6,059.16
$1,000.00 I
$1,970.00 i
$10.95 i
$1,000.00 !
I
$700.00 I
I
i
$132.00
_--+---- I
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$68,184.67 i
$506.34 j
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@2D08 MEMBERS 1ST FEDERAL CREDIT UNION
MECHANfCSBURG, PENNSYLVANIA
https:llml online.members 1 st.org/OnlineBankingl AccountSummary I AccountDetail. px
Page 2 of2
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$58,082.90 I
$57,950.90 !
$64,010.06
$65,010.061
$66,980.0~
I
$66,991.011
$67,991.011
$68,691.01
$506.34
lNTERNET TERMS OF USAGE ( PRIVACY 31 A TEMENT l FRAUD & SECURITY CENTER
3/28/2008
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Account Detail
View Account History
Account: 500 - REGULAR SAVINGS
Balance: $5.00
Available: $0.00
Last Activity Date: 8/23/2007
Reg-D (What is Reg-D?): 0 transfers, 6 remain
Reg-D Transfers: 0
Reg-D Checks: 0
',-~.__._-~_.~._---.._~-~----~.~_.~--_._---
Change Account Qescription
Please Note: The use of inappropriate language in personal account descriptions will result in the removal of this privilege.
r.~en~_~~_Transac~ons
View AccoiJnt Hjst~._______________.____.._____._.
500 - REGULAR SAVINGS
No Transactions Pending
___~~c()u nt. H ist~!Y-___\I~.":'~~u fl!..Q~t?.iL...-.-_____.___.__._
Account History: SOO - REGULAR SAVINGS
Cleared Date:
All
Last 30 Days
Last 60 Days
Last 90 Days
E
Last 120 Days
Date Range: 7/1/2007
'E - 3/2812008
Show Only: Any type of transaction
Description:
Check Number:
Amount:
~~ 1--1
~Printer Friendly
Download for:"'Money/Quicken 99 & Later "'Quicken 98 ~readsheet "'Web Connect OFXI F!Q~____________~
r--D~ I Desaiption . - f Withdrawal! Deposit I Feel Inti Balance!
. ~S/2312007 To Share 11 ------J $34,983.70J Ii -t--L-=- $5.~
i I 08/22/2007 To Share 11 (08/21/2007) I $12,000.00 I . I ! $34,988.70 i
[q:8/20/2007 To Share 11 I $10,300.591 1 I I $46,988.701
: 08/20/2007 To Share 11 I $364.231 ~ \I~ ! $57,289.29 J
i 08/20/2007 To Share 11 ! $130.88 i I I $57 653 521
, i 08/20/2007 To Share 11 i $68.501 I ~~$57'784'40i
f---- i I I' '!
~/20/2007 To SNELL,NICOLE L 0000210089 Share 11 I $80.001 i I I $57,852.90:
08/18/2007 Cash Withdrawal I $150.00! ;-i-r $57,932.901
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3/28/2008
OMS No. 1545-0119
~@07
Form 1099-R
Total nti
distribution L:.J
RECIPIENTS name, street address (including apt. no .j, City, state, and ZIP code
ESTATE OF CAROL HEADLEY
34 W. KELl.ER ST.
MECHANICSBURG, PA 17055-6339
Substitute Form 1099-R :!i1ID07
1514076
;,.
.
..
R~-1511. EX+ (12-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule L
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
FUNERAL EXPENSES FOR WILLIAM H. HEADLEY (HUSBAND)
FUNERAL EXPENSES FOR CAROL A. HEADLEY
BURIAL PLOTS - GRANTHAM MEMORIAL PARK AND INTERNMENT
6,300.59
6,369.40
750.00
2.
3.
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
3.
Family Exemption: (If decedenfs address is not the same as c1aimanfs, allach explanation)
3,500.00
Claimant Nicole L Snell
Street Address 34 W. Keller St
City Mechanicsburg
State PA .Zip 17055
Relationship of Claimant to Decedent
4.
Probate Fees
110.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17,029.99
-..-..................&..... ..L.L.&.A.'-+o.......
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Check Image Close
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MECHANICSBURG, PENNSYLVANIA
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@2008 MEMBERS 1 ST FEDERAL CREDIT UNION
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iNTERNET TERMS OF USAGE I PRIVACY STATEMENT I FRAUD & SECURITY CENTER
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REV.1~i12 EX+ (12.{J3) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUllES, & UENS
ESTATE OF
Caml A. Headley
FILE NUMBER
21-07-0642
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
5.
Statewide Tax Recovery - Past tax bill 123.96
Statewide Tax Recovery - Past tax bill 87.18
Orthopedic Institute of PA - Medical bill 15.00
West Shore EMS - Medical bill 25.00
Q Card - Charge Account 364.23
Cost of Estate Checks 10.95
Cingular Wireless - Cell Phone 199.38
')
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4.
6.
7.
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
825.70
...
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Customer Service 1.800.367.9444:1
Servicio at Cliente 1.800.328.089(
Payment Address OCAAD PO BOX 530905 ATLANTA, GA 30353-090~
Billing Inquiries aCARD PO BOX 981462 EL PASO, TX 79998-146.
Account' 613 9002 9330
Statement Date: 07106f2007; Days In Period: 30
$1,200.00
$835.00
$364.23
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Post Date rran Date Order Number Item # Descriotion
Amount
06/06
06/06
06/07
06106
06106
PAYMENT-THANK YOU
'FINANCE CHARGE' PREY CYCLE PURCHASES
- $100.00
-$0.05
$27.54
06/06 3354128077 T22536 FAN YANG'S UNBUBBLELlEVABLE BUBBLE MAKER
& BUBBLE BLASTER
06/07
06/07 2991433550 F178919 BACK PACK 7 PC GAME COMBO
06/08 2991476670 A71417 CAROLE HOCHMAN SET OF 2 SHELF BRA
CAMISOLES
06108 2991476670 A59728 DENIM & CO. STRETCH ZIP FRONT CARDIGAN
AND T-SHIRT
$26.46
$31.23
06/08
06108
$40.64
-
-
-
-
-
-
-
-
06130 06130 2992815163 H03713 HEIRLOOM DESIGN PATCHWORK LOG CABIN ALL
COTTON KING SIZE QUILT
06130 06130 2992815163 H98383 NORTHERN NIGHTS EGYPTIAN COTTON JERSEY
KNIT KING SHEET SET
07101 07101 2992815163 H03714 HEIRLOOM DESIGN PATCHWORK LOG CABIN ALL
COTTON QUILTED SHAM
$46.99
$74.43
$42.10
=
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-
-
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-
07/04
- $200.00
$6.67
07/04
07106
PAYMENT - THANK YOU
'FINANCE CHARGE'
07106
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PAYMENT DUE BY 5 P.M. ON THE DUE DATE. We may c:onvertyour payment Into an elec:tronlc debit. See reverse side for details.
NOTICE: See reverse side for Billing Rights and other Important information.
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COMMONWEAllH OF PENNSYlVANIA
MERlTANCE TAX RElmN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Carol A. Headley
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RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
BER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Craig A. Headley, 712 South 48th Street Apartment B Tampa, FL 3361iJ son 10000.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
FILE NUMBER
21-07-0642
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REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2007-00642 PA No. 21-07-0642
Es ta te Of: CAROL A HEADLEY
IFirst Middle, Last}
Late Of:
MECHANICSBURG BOROUGH
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 172-32-0458
WHEREAS, on the 31st day of July 2007 an instrument dated
June 27th 2007 was admitted to probate as the last will of
CAROl. A HEADLEY
IFirst Middle, Last)
la te of MECHANICSBURG BOROUGH, CUMBERLAND County,
who died on the 29th day of June 2007 andr
~~EREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of wills ~n and
for CUMBERLAND CountYr in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
NICOLE L SNELL
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 COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 31st day of July 2007.
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
".
07~~ r;~
LAST WILL AND TESTAMENT
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I, Carol Headley, a resident of the State of Pennsylvania, County of Cl.!riIberland,
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and City of Mechanicsburg; and being of sound and disposing mind, do hereby make,
publish and declare this to be my Last Will and Testament, thereby revoking and making
null and void any and all other Last Wills and Testaments and lor Codicils to Last Wills
and Testaments heretofore made by me. All references herein to this Will shall be
construed as referring to this Last Will and testament only.
OF
Carol Headley
FAMILY CLAUSE
At the time of executing this Last Will and Testament, I am the widow of William
H. Headley. The names of my children are listed below. If I do not leave any property to
any of my children, my failure to do so is intentional.
Craig A. Headley
Nicole L. Snell
RESIDENCY CLAUSE
Having in mind the possibility that I may temporarily reside outside of, or simply
be absent from the State of Pennsylvania, County of Cumberland, and City of
Mechanicsburg, at the time of my death, I elect and hereby declare that this Will and each
and every disposition and provision contained herein shall be construed and regulated by
and in accordance with the laws of said State of Pennsylvania. It is my desire that this
will be probated in the State of Pennsylvania, my place of domicile, and that the principal
administration of my Estate be made in said State of Pennsylvania and that none of the
assets of my Estate which may be found in my place of domicile, be remitted to any other
jurisdiction for administration or distribution.
DEBT CLAUSE
I direct that the executor named pursuant to this Last Will and Testament review
(as soon after my death as practical) all of my just debts and obligations, including
funeral expenses and the expenses incident to my last illness; excepting those long term
debts secured by real or personal property which may be assumed by the Heir of such
property unless such assumption is prohibited by law or upon agreement by the Heir. The
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executor shall pay these just debts only after the creditor provides sufficient evidence to
support their claim.
My executor shall payout of my gross Estate, as if they were my debts, and
without proration or appointment, all estate and inheritance taxes, by whatever name
called~ (including any interest due thereon) becoming payable because of my death in
respect to all property comprising my gross Estate for death tax purposes, whether or not
such property passes under this Last Will and Testament.
I further direct that if any Heir or Heirs named in this Last Will and Testament
should be indebted to me at the time of my death, and evidence of such indebtedness is
provided or made available to the Executor of my Estate, then that share of my Estate
which I give, devise and bequeath to any and each such Heir or Heirs, unless I have
specifically provided in this Last Will and Testament for the forbearance of such debt,
unless such Heir is the sole principal Heir.
PRINCIPAL DISTRIBUTION CLAUSE
I give, devise, and bequeath to my daughter Nicole Snell (my "Principal Heir"),
100% of my gross Estate after payment of all my just debts, expenses, taxes and as
described hereafter;
I give, devise, and bequeath to my son Craig Headley the sum of$10,000.00
dollars of my gross Estate after payment of all my just debts, expenses and taxes.
ALTERNATE PRINCIPAL HEIRS
In the event that my daughter does not survive me, I give, devise and bequeath to
the persons named below (my alternate Principal Heirs), ifhe or she whichever the case
may be, shall survive me, all of my residue and remainder of my Gross Estate after
payment of all my just debts, expenses, taxes and alternate specific bequests, if any in the
percentages set for the below.
1. Name: Timothy S. Snell
Relation: Son-in-Law
Percentage: 100%
In case such alternate principal heir does not survive me, I direct that the
share of my Estate which would have been given to such alternate
principal Heir shall be distributed to: Craig A. Headley.
EXECUTOR APPOINTMENT CLAUSE
(A) I nominate, constitute and appoint my daughter, Nicole L. Snell, to be the
Executor of my Estate.
(B) If, for any reason, my first nominee Executor should fail to qualify of be
unable or unwilling to accept or to continue as the Executor of my Estate, I nominate,
constitute and appoint my son-in-law, Timothy S. Snell, to be the Executor of my Estate.
(C) If, for any reason, all of the nominees designated above in Paragraph (A)
and (B) should fail to qualify of be unable or unwilling to accept or to continue as the
Executor afmy Estate, I nominate, constitute and appoint my son, Craig A. Headley, to
be the Executor of my Estate.
EXECUtOR POWER OF APPOINTMENT CLAUSE
(A) All directives in this will that use by reference the word Executor mean
and include any person named herein as my Executor (or person representative, as may
be defined under state law) and any person who may be acting in either capacity, at any
time. Such person shall have broad and reasonable discretion under the directives of this
my Last Will and Testament with respect to any property, real or personal, left by or held
by me, or acquired by my Executor on behalf of my Estate.
(B) I wish my Executor to have broad and reasonable discretion in the
administration of my Estate, to have all of the powers permitted to be exercised by an
Executor under state law, and to be able to do everything he or she deems advisable for
the best interest of my Estate and the Heirs thereof, all without the necessity of court
approval or supervision.. I direct that my Executor perform all acts, take all such
proceedings and exercise all such rights and privileges. Although not specifically
mentioned in this Will, with relation to any such property, as if the absolute owner
thereof: and in connection therewith, to make, execute and deliver any instruments, and
to enter into any covenants or agreements binding my Estate or any portion thereof.
(C) No such person named in, or appointed in connection with this Will in a
fiduciary capacity shall be required to file any bond or other security for the faithful
performance of his or her duties as fiduciary in any jurisdiction; and if, despite this
directive, a bond should be required, I request that it be accepted without sureties and in a
nominal amount.
NON-LIABILITY OF FIDUCIARIES
Any fiduciary, including my Executor and any trustee, who in good faith
endeavor to carry out the provisions of this Last Will and Testament, shall not be liable to
me, my Estate, or my heirs, for any damages or claims arising because of their actions or
inactions based on this Last Will and Testament. My Estate shall indemnify and hold
them harmless.
SAVING CLAUSE
If a court of competent jurisdiction shall at any time invalidate or fmd
unenforceable any provision of this Will, such invalidation shall not be construed as
invalidating the whole of this Will. All of the remaining provisions shall be undisturbed
as to their legal force and effect. If a court fInds that an invalidated or unenforceable
provision would be become valid if it is limited, then such provision shall be deemed to
be written, deemed, construed and enforced as so limited.
IN WITNESS WHEREOF, I, the undersigned Testator, declare that I sign and
execute this instrument on the date written below as my Last Win and Testament and
further declare that I sign it willingly, that I execute it as my free and voluntary act for the
purposes expressed in this document and that I am eighteen years of age or older, of
sound mind and under no constraint or undue influence.
\~
(Signature of Carol Headley)
SSN:
Date: 6/;21/67
I
ATTESTATION CLAUSE
This Last Will and Testament, which has been signed by Carol Headley, the
Testator, was signed, executed and declared by the above named Testator as his or her
Last Will and Testament in the presence of each of us. We, in the presence of the Testator
and each other, under penalty of perjury, hereby subscribe our names as witnesses to the
declaration and execution of the Last Will and testament by the Testator, and we declare
that, to the best of our knowledge, said Testator is eighteen years of age or older, of
sound mind and under no constraint or undue influence.
~
1. ~~Q, ~
(Signature of witness)
L s,/\ A. \ I\ev{
(Print Name)
Date: ~ - d7- CI
~lLj U s,+e"-I~ '''j t~JY\
(Address)
127 r0\L-\. P,A jlDd- \
(City, State, ZIP)
2. ~~~I~
(Signature of witness)
c~"-~ t. ~ SJ (/ c~
(Print Name)
Date: .{; - 2- 7.0 '7
.s- 21:.'6 S 7'[,o7fLl-~ C.AS-~"..L
(Address)
;v-5..:~<-S ,7,--~ tO~ ("-2. )G
(City, State, ZIP)