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HomeMy WebLinkAbout03-0727PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of GARY D. HENRY No. also known as To: Deceased. Social Security No. 206 - 32 - 4365 Register of Wills for the County of CUMBERLAND in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is(~)18 years of age or older, appl I Eg for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. at Decendent was domiciled at death in CUMBERLAND County, Pennsylvania, with IS last family or principal residence at fill CENTF~ qT~FFT, Ca~ Tq~ r Pa (~ARLISt, E -- ' (ii~t ~tree't~-~u'n~ber-~c~n-u~i~i~alit~)' Decendent, then 61 years of age, died AUGUST 11, , I~2003 , 60 CENTER STREET, CARLISLE PA Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal. property in Pennsylvania $ (If not d6miciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: N/A 10:OOO.OO BORO) Petitioner S after a proper search ha S the following spouse (if any) and heirs: Relationship SON ascertained that decedent left no will and was survived by Residence 46 MT VIEW TFRRA£F: NFWVILLE SON DAUGHTER 79 HORSFKIIIFR RD. SHIPPENSBURG 61 MOUNTAIN ~;TRFFT; MT HOLLY SPRS. THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ; ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s)that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed /-X ,---before me this DONNA M. NO. 21-2003-727 Estate of GARY D. HENRY ,Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW SEP-Iq~BER 8~:~1~ 2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that BRIAN K. HENRY, CHRIS D. I-IEI~Y 31qD STACEY L. RUPP g/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to BRIgAI K. HENRY, CHRIS D. HENRY, g/qD-STAC~:Y h. RUFF in the estate of C4kRY D. HENRY FEES Letters of Administration ..... $ 40 o 00 Short Certificates~ ) .......... $15.00 ~~ICP .......... $10.00 $ TOTAL __ Filed .S~FISgMBER. ADMINISTRATOR WILL PICKUP LE%q~RS TODAY BEFORE 2.00 PM. 9/8/2003. ' ~ Register of Wil'l$ DONNA M. (7ITrJ, 1ST DEPUTY ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE 105.805 REV 9/86 CERTIFICATION OF NOTICE UNDER RULE 5.6(a~ Name of Decedent: ~ Date of Death: ~ -- c,~ OO 3 wi. No. To the Register: Admin. No. _ &!-oxoo -o 727 Ice. rtify that notice of (beneficial interest) ~state administration re'~uired b". ...... servea on or m ' · ,~ y ~xme a o(a) of the _Orphans' Court Rules was ruled to the follow~ ' · · ' · ng beneficiaries of the above-captioned estate on _t~)~-O'~--s~O,~ .: Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except_ Date: 6t:6~' g-SdV Telephone ( ~ / ~' 6~.5~''' Capacity: ~ Personal Representative / ~Counsel for personal representative Postage Certified Fee Postmark Return Reciept Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) ........ ~ sa~e, z~P*4 from item 17 Ye~ 1. , ' L I'1 Insured Mall [] C.O.D. · 4 pac,=ted ~ ~ ~) ......... ~ ~ ~ Return Receipt post~ge r~ Certified Fee ~ ~ Postma~ E.J ~ 1 Here C~ RetUrn Reciept. Fe?, ~ I r~ (Endorsement Requ~re~ ~ Restricted Delivery Fee~ (Endorsement Required) ~ . . , - :~.-. ~..,~ff, i~m4ff~ ~ de~imd~ · 7003 1010 0001 1203 7932 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/13/2005 RUPP STACEY L 61 MOUNTAIN STREET MT HOLLY SPRINGS, PA 17065 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, .~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge c0 (- I.' . c: F: c_~. Name of Decedent: Wrtt No.: A dm:iR. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes jgJ No D 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did t5 personal representative file a final account with the Court? Yesp NoD b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes IX! No 0 C> c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. r .~e(jf/!4YJ SIgnature . I .Stf1ety / I?IIfP Name , Date: !lh5/c :; ( . .' ~ -", it. / 07 OU't.r f( sj1f d Address (Iff & i'L (i ~0W"j(), Pf1 /7<Jtc S (7 J ?) '18 ~ .... ,';) 7 g :.1 Telephone No. ~. ....... c.') ~ .'-"l L ._1 c.....1 ('-.J Capacity: n Personal ReDresentative o Counsel for personal representative t_ G- STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ga.y f), H ~vli~r Date of Death: O~ -- 1/" ~ 00 3 Will No.: J.I-o 3 - o?~ 7 Admin. No.: Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether ad~tration of the estate is complete: Yes 0 No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: .T~ 1~1 ~606 3. lithe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 Date: c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and maybe attached tothi~ ~ lI-/t~oS- . gnature -Sr/~~ K Ueva\v Name ___ I 'it n 1: Vl~W I e.('('"ac. ~ N'Lwilil1e I p(/.. 17~ '1/ Address 7/7-- 7? {- (cr,{~ Telephone No. Capacity: 0 Personal Representative o Counsel for personal representative Vl; Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7 ) 240 - 6345 Date: 7/05/2006 HENRY BRIAN K 46 MT VIEW TERRACE NEWVILLE, PA 17241 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS 1 COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 8/11/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, l~ , "~~ ~ ~L-~"", ' }l(hM ./4' \ ~b~A.J ~, " " ",' ,. "~..tL7,-",,...... Vl.RMu / J Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 HENRY CHRIS D 79 HORSEKILLER ROAD SHIPPENSBURG, PA 17257 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, u ~ 1"1 ., ... .. . ,. <-. ,1._. _ ' _,; ( .' . " ):ti'~ '-' ' ,",-0 ~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 RUPP STACEY L 61 MOUNTAIN STREET MT HOLLY SPRINGS, PA 17065 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~ vlU'#cW:"--' > (J ;~16 I Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel \' In Re: Estate of HENRY GARY D ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYL VANIA Estate No.: 2003-00727 NO. 2003-00727 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: RUPP STACEY L Counsel for Personal Representative: Date of Decedent's Death: 08/11/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 8/29/2006 i2 I~ .4> ,( /; . .~) . tt.".' / z..... "'"~ .'. :1itt'$<_/ ~4h/'(4<{. . w",(/w"':~~ vt<>. .//! ~.,/ Glenda Farner Strasbaugh Clerk of the Orphans' Court =r LI1 ru o ~presentative a- fT] -D ru fT] D., o I 01. i ~ <1\I\c)\p o LI1 03 0/.3-, ~ R'Ltf''J ~e'i1 L '~"'1"..tPjJ;~,.~)J9t~ _ " ",.'.' ""'''''''''''. ,~~. " ,,'. """.."",,~;~m'~r'~~ lo, I~, cYuA {lG.h e: \ ~ In Re: Estate of HENRY GARY D ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00727 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: HENRY BRIAN K Counsel for Personal Representative: Date of Decedent's Death: 8/1112003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 8/29/2006 A V il"p J f) ~.?'l .l. '~uJ1'~~.a:f;l6 A/.,.{/ff't/'!.-!f'-.- v . ~/1 . u Glenda Farner Strasbaugh Clerk of the Orphans' Court U1 U1 r-'l o sentative 0- m ...n ru ~.\~~~\(C. m o o o o 0- m o 0-\\ 1\ Dlo 03-0ld.\ L.f1 o o ["'- \-\eX"\'<L\ ex\Cl.S\ \Z- '-\ \.i) ~ \}, \e..:.nr(~ n'a'\\ ~ In Re: Estate of HENRY GARY D ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00727 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: HENRY CHRIS D Counsel for Personal Representative: Date of Decedent's Death: 8/11/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 8/29/2006 '// (^;p ... /J P A"'-;'~ . .{ ~.. ..1 i/ V'1'hA;;G~ '~'tr./J J~,:./n~./'0 AL.{L/I''-'!.'-4'';".., Vl:N '., /J /. ru ...n ....=l o Glenda Farner Strasbaugh Clerk of the Orphans' Court :sentative a- ITl ...n ru ITl o o o o a- m o lo.\~~~-\-le q \, )tU 03 -C.~L:).I Ul o o f'- \\:(\ ~ C~~n ~b 'lq \llrs~ li\~ eooJ ~\ ~ SENDER: COMPLETE THIS SECTION I . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from it m 1? If YES. enter delivery address below: 1. Article Addressed to: HENRY BRIAN K 46 MT VIEW TERRACE NEWVILLE PA 17241 3. S rvice Type Certified Mail o Express Mail 'f;i( Return Receipt for Merchandise (fc.OoO. 4. Restricted Delivery? (Extra Fee) DYes 2. Article Number (Transfer from seNice labelj 7005 0390 0003 2639 0155 PS Form 3811 , February 2004 Domestic Return Receipt 102595-02-M-1540 ~ 1'\ H II Ii l t n t \! t t q Ii II' i i II' i i \1 H \ \\ i i \Ii n n i \ I Ii l i \ \Ii l i \ ~ ~ U! :~:.:: d :: :::: d! ::: : O~-8 'ON llWJa Sd P!8d saa:::J '11 aB8jSOd 1!8V'J SS818-1SJ!:::J SIOL I Vd 'gIS~PB;) gllmbs dsnoqllnO;) gUQ pUBpgqrnn;) JO AlUnO;) )lno;) ~mqd.Io JO ){lgI;) pUB smM. JO 19ls~'i3g~ c" M Lu::'-I.. .. q'i3UBqSB1lS 19WBd BPUglD C) ,-~: C\J I-- ct Q:. ::;: Q:: . l.J ., :a:b_. -- r" ~ ,C.LiC-J'C": . Oc' t.r) :x:: ~ ;.:. , .' , U:2'~ :.xoq S!LJe}! 17+~'EE'SSeJPpe 'eweu JnQA lU!Jd eseeld :Jepue8 . 3i L~LQ-tO 381M:J38 ll:/lS0d 8311:/18 0311Nn SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: o Agent o Addressee EUPP STACEY L 61 MOUNTAIN STREET NT HOLLY SPRINGS PA l7065 3. Service Type ~ Certified Mail o Registered o Insured Mail o Express Mail ~eturn Receipt for Merchandise [!J C.O.D. 4. Restricted Delivery? (Extra Fee) DYes 2. Article Number (Transfer from service label) PS Form 3811, February 2004 7005 0390 0003 2639 0254 c Domestic Return Receipt 102595-02-M-1540 ClJ"" '::" .~.i'.r'H"],rl , "I ' ,I. ' ,I. 1;.1. ,) ~'"'l\~l"'\" lP#" '''''' , ,', '. ','",m'I 'f'irsU'j,Q SS fJf~lli\"',"','i",' ','" !f+llllln'II\\\"" "'~e1r'~,~~ USPS , HIfJ f~lfilil}ttlt~J:f' e' l~iW~j-1 0 ".'''.....11-'..' ...~.'nm'llt ' UNITED STATEfB9,p:Ttt:P-~Ij!;Yi9~;~( 'rJll'ifli<<IUIHYJJlll1" · Sender: Please print your name, address, and ZIP+4 in this box · %"#f1tJ .-.-..-..-. : : ~: :.... o 3-- o'l2l-l ^ ..\ I ~o ~,i Glenda Farner Strasbaugh ffi~o ~ ;' I Register of Wills and Clerk ~6ans'lJoud_;:-1:-: 1 , County of Cumberland es~c; -0 s..o~ I g:i~~~~o~;~~rrc :~~ : "'hli 0' . L II il i 11,111 , , IIII U 111111111. ! I /1111 i Illl'lllllllllll/llll, i SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY HENRY r':HRIS D 79 HORSEKILLER ROAD SHIPPENSBURG PA 17257 -u . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: 3. Service ~ 0 J' ]$:certified Mail 0 Exl'f'eSs Mail ~g,,,t.....n ~eturn Receipt for Merchandise o Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes 2. Article Number (Transfer from service label) PS Form 3811, February 2004 7005 0390 0003 2639 0162 Domestic Return Receipt 102595-02-M-1540 I UNITED STATES POSTAL SERVICE CC:C:2 First-Class Mail Postage & Fees Paid USPS Permit No. G-10 · Sender: Please print your name, address, and ZIP+4 in this box · D3 - bl6:--"l .~ Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court County of Cumberland One Courthouse Square Carlisle, P A 17013 i il! i ii! I I j iL 1111111.1 i\ 11 Iii III iL 11 L ill i L j Ii II j ILl j I j III Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 NameofDecedent: GC\-'j \:) \'\cNl ') Date of Death: <6 ~ \ \. O~ Estate No.: dtJJ3 --CO 1 cX7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the adnlli"1istration of the above~captioned estate: 1. State ~ether administration of the estate is complete: Yes J.)!i. No 0 2. If the wiswer is No, state '\vhen the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did t~ersonal representative file a final account with the Court? Yes j2q No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the persop.~representative state an account informally to the parties in interest? Yes qy No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: q ,\.do Sf(J(?tcl L. f!(J (JjJ Name.J I ~/ f!l/jlfih/l s,f Ad~ress j)tJ. . 0 t'l ~pu"t''-t?/) (jJII / ):)/;;5 ~glR -,57l(3 Telephone No. S I .il!! I ., I 'If'~.a.c""'~ '(,,;'J (, (!.x.'t1~fl.~tty: o Personal Representative o Counsel for personal representative 't .."JI ~. U._-~ CJ LT- u-- C) ~C~j C:C C~' -~ ~7~! JS' Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: GeM:. 7 D. fie vl ry Date of Death: 015 -/, - ;?60 3 Estate No.: ,;{ 00 3 ,- 00"7 A 7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether ad~ration of the estate is complete: YesD No~ . 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Fe.1t1 ~) ~OD 7 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. . . ~~ ~__ Date: 0 ?-'l- :<ooG ~ SIgnature '1; ri~'1 k~ f-IeVlI''j Name '16 .ut l)l'ew kCrdce Address co .. - - ::c lid: ...-_-_"1 G l;..:: . ---I \ c5 ~=~, '. ~c,'.:. a:: "-7' ~l~; 0\ (~:::. 6~) L) 776'- 6c.r6~ Telephone No. Capacity: ~ersonal Representative o Counsel for personal representative tr> 0- l.U (/) ...a c=> ~ ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 7/11/2008 HENRY BRIAN K 46 MT VIEW TERRACE NEWVILLE, PA 17241 RED: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: ~._, C7 ca ~, .: -- ~-- ~._ ~. :-~-, --- /\ _ __ -.. ~ ;; ~.., 3 ,. , ~ - , -`: ; This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, f ~~~t%t7~G ~J"GGU.~I •t~ l~r Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/11/2008 HENRY CHRIS D 79 HORSEKILLER ROAD SHIPPENSBURG, PA 17257 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: C"7 ' ~ r"~ Q w ; t- _= ~, - ~- - i. -~ ; ~ .\ =7 -' ,'' ~- ~ `- -,, ,..- - ' -. , ... r.. , - - ,. -F.~ T _~ __Y ~ -i ~~ rv 0 This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ,U Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 7/11/2008 ~? `' -Y C7 ~~ RtJPP STACEY L -~ r_~ 1° ' ' ' 61. MOUNTAIN STREET > r, .~-- -~-' PA 17065 MT HOLLY SPRINGS ., ` ;"= ~ ., -a -.- , ~ . -- _ _ _ , - .. r..,3 RE.: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: This. notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8f11j2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Pa. ~.C. Rule 6.12 S'TA.'I'LTS RBI'®RT REGISTER OF WILLS OP ~ x"''11 ~~ ~°~-~'' COUNTY, PEN`NSYLV~NL~ Flame of Decedent: i Date of Death: tt ' ~ ~ ~ ~I~x e~Tumber: ,~ O0~?i ` Q a r~.,,- ++n ~., n r v i ~ i ~ r o,,,,,-+ the fnlln~xrina tzrith reC„P.rt to rmm~letinn of the administration of 1. uLJUaiit w ~ u. v.~~. ~~C..e ~. «, , r..Nvi~ ..,~... ..~ r--- r----- t:he above-captioned estate; 1. State whether administration. of the estate is complete :.................... Yes No 2. If the answei is No, state when the personal representative reasonably believes that the administration will be complete: CQ dd 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ....... QYes ~ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... . C~ Yes 0 No d. Copies of receipts, releases, joinders and approvals of fozzrzal or informal accounts may be filed with the Cierk of the Orphans' Court and maybe attached to this report. ,~} /~'~ Dnte V ~_ v Signature ofPers~on Fi in, this Form Capacity: [Personal Representative ~ Counsel 'o'~~ _r,r, ,~ ,---, ~ftan ~• ~Qx.r-4 NmnJe~of/PersoAn~,Filin~ this Ffarm Addr ss ~~wv~l~ ~d ~~a,~l Telephone FormR~i'-f0 ~ev.lD.13.0G ~a. ®.C. Rule b.12 S7C~.~I'IJS RAP®R`1' REGISTER OF WILLS OF Name of Decedent: COUNTY, PENNSYLVANIA Date of Death: ~- 11 - U ~ File Number: c~Q03 -C~17~ o~~ D.,.-,,,,.,,,++„ D., n t`' r)„lo ~ 1 ~ T ,-o,~(„-t the fnllnwino ~z~ith recr~ent to rnm»letlpn of t~le ad71"111-ilStratloll Of i uL~uuiL~ w i u. v.~. i~ui~. v.i_, i...r..........v.........a r'-- -~ r- the above-captioned estate: 1. State whether administration of the estate is complete :.................. . . ~ Yes No 2. If the answeris No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: - - a. Did the personal representative file a final account with the Court? ....... ~ Yes ! No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account - - infornlally to the parties in interest? ............................... ~ Yes No d. Copies of receipts, releases, joinders and approvals of foiznal or informal accounts may be filed with the Cierlc ofthe Orphans' Court and maybe attached to this report. Signature of Person ,, F rm Capacity: ersonal Representative QCounsel Form RN'-lD rev. 10.13.06 Name of Person Fili g this Form ' ~~ j m.~~ta c,r~ ~f Address J t2 I^? S Telephaie I N R E ESTATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA GARY D. HENRY ORPHANS' COURT DIVISION DECEASED NO. ~'~iCiYl ~ ~ - v3-`7a~1 PETTfION FOR CITATION TO THE HONORABLE THE JUDGES OF SAID COURT: AND NOW, this \ S~~ day of ~ y a,0\0 . ar~c- comes the Commonwealth of Pennsylvania, by Robert Freedenberg, Deputy Secretary for Taxation, for C. Daniel Hassell, Acting Secretary of Revenue, who avers: 1. That Gary D. Henry, deceased, (hereinafter referred to as "the Decedent', died on August 11, 2003. 2. That a Petition for Letters of Administration was made by Brian K. Henry, Chris D. Henry and Stacey L. Rupp, Co-Administrators (hereinafter referred to as "the Co- Administrators"). Letters of Administration were granted to the Co-Administrators on September 8, 2003. Attached hereto and made a part hereof is a copy of a document attesting to said date on which Letters were granted mazked Exhibit "A." N n ~_ ~ t ~ ~ f ~ ~~` „1V1 ( i r I ~ ~ ~ C7 _ ~~~ _ ~Sl ~ N T..~ ~ E,'J ~ ) O V- V 3. That on July 8, 2009, a certified demand letter was sent to the Co- Administrators, advising that the Inheritance Tax Return for the Decedent had not been filed. A receipt was signed and returned to the Department of Revenue. Attached hereto and made a part hereof is a copy of said letter and receipt marked Exhibit "B." 4. That as ofthe -date of this Petition no Inheritance Tax Return has been filed by the Co-Administrators of this estate as required by Section 1736 of the Act of December 13, 1982, P.L. 1086, No. 255, (72 P.A. C.S. § 1736). 5. That under Section 2176 of the Act of August 4, 1991, P.L. 97, No. 22, (72 P.S. § 9176), the Secretary of Revenue is authorized to request the Court to issue a Citation directed to those subject to any duty imposed by the aforesaid Act, commanding such persons to appear and show cause why the requirements of this Act should not be met. WHEREFORE, your Petitioner prays your Honorable Court to issue a Citation upon the Co-Administrators, directing the Co-Administrators to appear and show cause why said Inheritance Tax Return in the estate of the Decedent should not be filed as required by law; and to fiuther direct that the costs of this action shall be borne by the Co-Administrators. PENNSYLVANIA BY Deputy Secretary for Taxation FOR: C. Daniel Hassell Acting Secretary of Revenue COMMONWEALTH OF PENNSYLVANIA • ss COUNTY OF DAUPHIN Robert Freedenberg, Deputy Secretary for Taxation, for C. Daniel Hassell, Acting Secretary of Revenue, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Petition are true and correct to the best For: Sworn to and Subscrib before me this ~% ` day of ~.C9~~ , a DO 9 COivifvli~idWEr".wTH OF PENNSYLVANIA Notarial Seal Sue E. Hetrick. Notary public City Of Hamslwrg, Dauphin County My Commission Expires Apr. 10, 2010 Member, Pennsylvania Association of Notaries Robert. Deputy ledge, information and belief. for Taxation C. Daniel Hassell Acting Secretary of Revenue Page 1 of 1 OATH {}F PERSpNAL E~EPREBENTAT'1'YE CdMkMi(1NWEALTF[ OF PENIVSYLV,A,IYCA Ciy~31~iTY OF CUIdBERLAIi© ~ ss The Pttitionerpl abovo-tulmed sxeartc} a affkrta~s} that the ctatcmeats isy the fatesoiag paition art true ami oorrncs W the brtist of the kaowlod~c and bdkf of t>ecida»a(c) sttd that u persona( tq~ttseutattve(s) of the shove dsoedent peliti~er(r) wilt axll and trutp admfnieter the state aocarditsy to law. . Sworn to or affirmed and subs~atvbed ore rne~~_~~y~ j~jp, 21-20D3-727 F.dt!#~ OL GARY D. tfENRY Uect>,d GR~l1VT IJF L~TT'ERS OF ADMItr1ISTRATIUIY m l'n Alva faaw ~ 8ita the revese sick hereof; sstisfaetory fnonf hav ~~ ~3• io onrisitletation of the praitioo na ini hods prtsaprtat heltMS trte. iT IS a that 1'~31At1 K, ttFalFtY'. GIRLS D E11~IR1( Atm S7"M_EY [. 4dtPp tVare artitkd ra I..seteas of Admitdstiatfwt, and to aaetnd vrlth such fln ~i. 1-otters of Admltdstiauan are herM,,p ~rauted to BRIAN K. _ r _ "c.4~av~~-~-~.~»....____ !n tht: tstate of D. _- t~t~ ~o.tx} Lettars of Azatloa ..... 5 Short Crarttitcatee~ ) ....... .. 1~_ ~.7eP.....,..., S~n_nn S TOTAL ,~ g6~,_00 F31od Sx+P'tifi19~R. !3'IVi.. 2Q0A.a. >~Snstnacx y, '°.~ t~eelr/rs pt K`Il1,F ~,~ D,t~IMfA MI. Cliiif. 1ST QE~1JtY A7?4RNI:Y 6SUR. th. I.D.. Na.t M»Dxsss AOINTN2S7'ttA'It;lit wLlld. P1CK UP [.b"1•i'E125 4'L~AY EEFUft>r 2.t)A PN1. i'ltotit 9/gf2003. `.J.' - . http://records.cc a.net/weblink ublic ~' p ~ -print/ImageDisplay.aspx?cache=yes&sessionkey=... 11/12/2009 Page 1 of 1 PETITI©1'rt FUR. GRANT i}F LE1"TFEiS OF ADMi1~ttSTRATION Fsrart of fdtRY 0 HE,,N„~Y Na. ~„'~~•,~~~•~.I~f dtto known ax ... To: -~--.... Registsr of \4'ilts far tlrt county or C'JNBERtAtaa io ene 5orial Sacurtty Na. - 32 - A365 Cammanwealtlt or rtnneytvaaia T'ht pr:ttttaa or the undrrsiynrd rapersluttr represpns tha: Taut Petidaner{s), w.hd is are 8 yen or agt ar otdcr, appt 1 ~S Far lerttrs of tdminlstratron rd.6.e.; ~ L/t, duea,¢e sMmtia,; dYesw,ee mimriutrl Oa th! CStat! OF flit al7ave Je~em. Dettndmf was domlraled at death in CUMBERLANR 1>_-I~ last FrurulY or rinci al Kn r id Caunty, Ptanaplvanld, wifh ._._. P p r~ tace at AR C 9480 j fF.t nraai, mras and swai~.7ity') 1]erendrnr ripen ~'~._ YY~~rma aP age. died /rU6LFCT 1 ~, at_ (iQ CEfi~ER STRE~7 ~ARL'SLE PA . ~~_, Decendenr u death rsr»cd PtoPettY xit6 assitnared talon u Fattlowt: Qf daeniciiai in Pa.) Ail pasansl P~vPertr tiF not dpnticitd is Pa.} Pasanal MaPertY in Pennsylvania 3 i4 . nn,.,.T n„ n~__ (ir na domidif:d in P#.# Pcnaoal PraP~tY In County ~ ~------`-- vaiut of rtsaF tame In i~ennsylvania s strtatcd u Fallawsr N/A P~tiaoa~-- niter' a prpPer seaxc4 ham ascrttasntd ahhat dan6ani ki'r ao wi9 and was survivmd by the Fo[Ipaing spouse (iF any) utd belts.: RS. x I,L~' .p'J r~ r ! ,.yt_- http://records.ccpa.nedweblirlk ublic ~ ~ -print/ImageDisplay.aspx?cache=yes&sessionkey=... 11/12/2009 T'HEREEFORE, pettio~(s# respertiullY roquestGs) tht grant: aF lrrtters of admininaatioet in she aP?rnpriate form to the anatrsigned. r , COMMONWEALTH OF PENNSYLVANIA s"rn~nw~e a~°Y 1~"`TOe'"~ DEPARTMENT OF REVENUE a7N s wAt.HUr~rs HARRISBURG PA 17128-0101 REV-869 PO APP (07-08) BRIAN K HENRY Date: 7/8/2009 46 MT VIEW TER Estate of; NEWVILLE PA 17241 HENRY GARY p Date of Death: 8/ 1 1 /2 0 0 3 File Number: 21 0 3 - 0 72 7 Dear BRIAN K HENRY: (Certified Mail-Return Receipt Requested) Department records indicate you are responsible for the settlement of the above. estate or that you represent the responsible party. As of this date, you have failed to resolve this matter, ^ ~ ~ ate kerns 1.2. and 3, Also compete ^ Print y ur ned ~~ is desUed. ~ that we can r~m~e~ on the reverse • Attach this card to the hac-cardof the mailpiece, a on the front h space Permits. ~' Arflch>r Addressed to: BRIAN K HENRY 46 MT VIEW TER NEV4'VILLE PA I7241 21 03-0727 DIBARTOLOMEO "' °`°'"° °a ~+*Pmains unsettled. a sb„ I ayment of X ~,t. E estate within nine s ~ Nei shred by !mains open because: p, ~ ~~ of a (FILED. M YES, en pP~ s~, a ,its was opened for the ~ ~Q-gyp, i .the proceeding in writing ~ ~" , ~ a. ,ryv. E -_ P~ O~E~~' 'd to fees of up to lent, may be ' ^ insured • ~;~?,,; .-: ' , ` ' f °r ~imndlse ~.D r contract counsel. r• Article Number 4: p~+rlcEBd neN~,y1 fF~a ~ ;Department Of '~"'~ 7003 1680 0~0^ 9622 7223 ^~-A finding of contempt in '3 Form 3811, Fetxuary p004 c,umoer2a2.2 ~~,. "° R~"rr' ~~+ !by the Orphans' Court of 7a2sas.~,M,r~.', RETURNS SHOULD BE FII,ED AND CHECKS MADE PAYABLE TO: REGISTER OF WILLS, AGENT Sincerely, Anastasia Di Bartolomeo Direct any questions regarding this estate to HARRISBURG DISTRICT OFFICE STRAWBERRY SQ 4TH J~ WALNUT STS HARRISBURG PA 17128-0101 (717)787-3863 cc: STACEY L RUPP 61 MOUNTAIN ST MT HOLLY SPGS PA 17065 ~IIBIT B HARR44BURC DLYIRICT OPPICB SrItAWBBRRY SSpp 9TH d WALNUT3rS HARR4YBUR0 PA 17124-OIOI i CHRIS D HENRY 79 HORSEKILLER RD SHIPPENSBURG PA 17257 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Date: Estate of: HENRY Date of Death: File Number: R8V-869 FO AFP (O7.Og~ 10/27/2008 GARY p 8/11/2003 2I 03-0727 (Certified Mail-Return Receipt Requested) ^ ft~ Plate hertts 1.2. and 3. Also ~Plete ^ Print you estrlcted Delivery la desired. So that ~~um~dress on the reversr ^ Attach th ~ ca-d to you. card to the back of the mailpieq or on the nt H space Permits. • Article Addressed to: CH)~ D HENRY 79 HORSEj{iT i ER Rp SHIPPENSBI~G PA 17257 21 030727 DIB,yRpl,(~MEO ArtIGe Number QAPns>er ham servr'cs raj above estate or that you ~e this matter. unsettled. d payment of 7 estate wtthm AIIIe remains open because: FILED. ~ °~1°1° luell state was o erred for the P o cROn e'~`M°° >"f the proceeding in writing ebn,ary2ooa -- ' ''"" yytl3 ited to fees of up to Retum Rer~lpt hrtent, may be imposed oti anyuaou2~y 2,~~ r..,~ , r""' -- -- °~~""-~~ or contract counsel. This notice shall serve as a formal demand on you or your client from the Department of Revenue. If you fail to file the return, the Department may file a citation requiring you to appear in court to show cause for your failure to comply with the law. A finding of contempt in this matter could subject you to additional penalties and/or incarceration by the Orphans' Court of Cumberland County, RETURNS SHOULD BE FILED AND CHECKS MADE PAYABLE TO: REGISTER OF WII.LS, AGENT Sincerely, Anastasia DiBartolomeo Direct any questions regarding this estate to: (717)787-3863 HARRISBURG DISTRICT OFFICE cc: STRAWBERRY SQ BRIAN K HENRY 4TH .>,~ WALNUT STS 46 MT VIEW TER HARRISBURG PA 17128-0101 NEWVILLE PA 17241 . __, o„w. aeOVerY address below: `~ 4 O ~~ O U, N Z _ _ O v 0 ~ W N W J a 0 1 w `a"` ~~ ZO w_ y w~ w N ¢ J U f4OvU © ~ F O ~ 0 Q ~ W ~~aa >a~a x ~om~ '~ .e i ~i 3 c~.lll t~l } ~I LQ ~I r O ~~ ~~ ~I J_ ,' W F W J J 31 o I V1 W ac ~ W w O O W U O I LL o -~ ~J a ~ U W Q Z Zt(, W ~ H H W ~ 'V ~ H J ~ O W ,' LL ..~ 0 0 .. JAN 21 2010 I N R E ESTATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA GARY D. HENRY ORPHANS' COURT DIVISION DECEASED NO. ~.l~~j -. ~~'~..'~TERM ORDER Now, to wit this the ~ 7~ day of ~~K~` ~a ,upon consideration of the foregoing Petition, it is ORDERED and DECREED that YOU, Brian K. Henry, Cluis D. Heiuy and Stacey L. Rupp, Co-Administrators for the Estate of Gary D. Henry, deceased, are hereby +~ r cited to be and appear at Courtroom No~..7 , on the ~ ay of~j , in tl~~rthouse of Cumberland County, Pennsylvania, at~~;QQ~then and there show cause, if any there be, why the Inheritance Tax Retu~7i in said estate should not be Filed; and to finther direct that. the cost of this action he borne by the said Co-Administrators; said citation rehul~able at /~: G~A~$, /'N on the ~~ay of /~1~~L ~~a BY T~E`CC ~... ~'~ ,. . t.LJ LI - _ f.i. ~,__. - ~'' ~~- ' ~ ~~ c ,-; < < < + L`.J L: _` `~.--- ti ORPHANS' COURT DIVISION J. cV ~-- fJ 3 N ~~ "Q o ~~ N CJ In Re: GARY HENRY ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA N0.03-0727 ORDER DATE: JUDGE'S INITIALS: TIME STAMP DATE: IN RE: CERTIFICATE OF SERVICE OF ORDER SERVICE TO: PA DEPT OF REVENUE CHRIS HENRY BRIAN HENRY STACEY L RUPP METHOD OF MAILING: ® USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 01/27/10 ENVELOPES PROVIDED BY: ® PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT SERVICE TO: METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ` ENVELOPES PROVIDED BY: ^ PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT 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 I NVOI Bill To: InvoiceNo: DEPT OF REVENUE- BUREAU OF INDIVID Invoice Date: REPORTS RECONCILIATION DNISION Estate of Estate No: PO BOX 280603 HARRISBURG, PA 17128-0603 Qty Fee Description Fee Total 1 PETITION 15.00 $15.00 3 CERT COPIES 5.00 $15.00 Total: $30.00 ~n~UiC~ ~ ~~ - ~(Ol~l>Qr 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. 2838 1/19/2010 GARY D. HENRY 21-03-0727 wz 15056051058 REV-1500 a cos-05) . ~ ~Y FA Depalbnent of Itevsrere Carly Cade vrx Rb Namber Bureau of txiridrel Tales INHERITANCE TAX RETURN PO BO7(2sO80t 21 03 727 IlsrrfeAup, t+A tTt230801 REi8~ENT DECEDENT ENTER oECEOEtrr ttiF~MlMATION BELOW Soasl SeaxKy Numbx Date d Death Date d Birth 202-32-4385 OeoedenCS Last Hartle F~~ 04/18/1942 Decedent's First Name MI Gary D Henry (N Applbwle) EMx StevhAtq SPlteta'a IrrTormaflort Below Spouse's Last Name Sttfflx Spouse's First Name MI spouse's soap seaatty Number THIS RETURN MUST BE F1LED W DUPLICATE WRN THE REGISTER OF WILLS a7l.L IN APPROPRIATE OVALS BELOW ,~; t. Orlyind Realm _._. 2.3upplamerrt.l Retum c.°'; 3. Ramalnder Rehml (da0e d deaM prior tD 72-13$2) 4. Limited Esfete .-__:4 4a. Future klterest ComprornNe (dab d ~.:. W :: 5. Federal Estab Tax Rehrm RetWirod dsNh affix 12-122) B. Decedent Dlsd Tbstele c~~ T. Dsoedett Mated a LINng Treat 8. Taal Numlrr d Seta Deposit 8wre (Attach Capy d VJiB) (Atfaetl COPY d Tort) 9. Litigetlon Proceeds Received ' ::. 10. Spapd PovarlY Cra#t (dale d death :::::': 11. Ebcilon b tax under Sea. 9113(A) belWeMt 12.31.91 and t-t-95) (Attadt Sch. O) (ONDENT - Tt11S tlECiION MUST BE f.'OIVLETED. ALL COttRElPDIApICE Alm Al. TAX NFOIIMATiDN 1kI0UtD eE OMEt:TED T0: ~~ Daypme TeNrthorre Number Brian K. Henry Firm Name (MApptlcable) First Ifrte d address 46 Mt. View Terrace Second Nrte d address City or Post OBice Newville CorrasponderlCs e-meki address: S unaerpeneab.atperp.~.iaecar.thai k to true, cam and car+Pele. 08/11/2003 aarr tiro State ZIP Code Pa 17241 (717) 778.8462 ~, o REGISTE~~I LLS USE ~l.Y -r~ - Y-, ~ ~ ,. ~ ~7~ ~ t ~ r ~ ' ~ ~ C.f..~ ~.-~~~ -~ ~ t~ ~ -z't r'~.~~~-fin ~ ~. -~7 " ,, ~ ~ ; 7 DA~FILED ~ _... .. _.. ...: q ~ eei+eadae arxi etatsrtrerae, and to the aeu at my wlawM . serarW raaearluave k based m as Mlbrmeaorr et vMM prepxar Ire arhr a 3-a~ - aoto SIGNATURE OF PREPARER OTFIER THMI REPRESENTATIVE DATE ADDRESS PLEAtN! t=OIIY ONLY Sloe 1 L. 15056051058 15056051058 _ ,..:^., J 15056052059 REV 1500 EX Decedent's Soeiel 3egxily Nrsnber I~~eerrrs ~»: Gary D Henry .__ ~ _..__.. 202-32-4385 _..__.__._....____-__ .________.._. _..,_M .,___ RECAPRULATtON __-------.____ _._ ._ ._. _ __ . .. _. _._.__ _ _..___-.. 1. Real estate (SchedrAeA) ........................................ ..... t. 0.00 2. stocks and ~orbs(Schedrrle B) .................................. ..... 2. 0.00 3. Closely Held Corporation, ParbreraNp or Sole-PrpP-iabrsfdP (Schedrb C) ..... 3. O.OO 4. Mortggpes a tVOFss Reoelvabb (Sdredrrle D) ........................ ..... 4. 0.00 5. cash, Bank Deposits a MisoeAarraous Personal a-oPenY (Schedule E) ... ..... s. 7,968.66 B. Joirlly CJwned aroperty (Sdredrrle F) ~ ~~ a Saparale one Requasfsd .. ..... 6. 0.00 7. In6er-Vlvos Trar~fers a AA~aneous Noo-pnppete property (sriredule Q) c,r~ separate BiMn9 Requested... ..... 7. 20,204.46 8. Tehl Gross Assets (total Lines 1-7) ............................... ..... 8. 28,17$.12 9. Funeral F~errees a AdrN~tratwe Costs (Schedule H).. ... .... 9. 8.337.50 10. Detrts d DeoederM, Morige9e UabiNtles, 8 !.fens (Sdredule I) ........... ..... 10. 200.18 11. Total DsduoUars (tom Lkres 9 & 10) ................................... 11. 8,537.88 12. Nst Villas of Estab (Line 8 rNnus LMe 11) .......................... .... 12. 19,635.44 13. Clreritable and Gotiertsrrarrlai Begrrests/geo 9113 Tnads Tor vrhlch an elecilon lD tax Tres not been made (sriredule J) ........................ 13. 0.00 14. Nst Value SulrJsct to Tax (Line 12 minus lkre 73) ............. . ...... __ ---._..__._........m,_,. _.__.._.____~_____,__ .... 14. 18,635.44 .__.___.___.. AX COMPUTATION • SEE BISTRUC71pNS FOR APPLICABLE RATES 15. Amount d t.kre 14 taxable art taro spousal ter rs1e, or transfers urber sec. 9116 (ax1.2) X .0_ 15. 18. Amamt d IJne 14 taxable at ICI rate x .0 ~, 16. 883.59 17. Amount d Line 14 Taxable at 9 rate X .12 n. 18. Amormt d urre 14 Taxable at ooNateral rate X .15 18. 19. TAX DUE ..................................................... .... 19. 88$.59 20. FILL IN THE OVAL IF YOU ARE REpUESTINf3 A REFUND OF AN OVELZPAYMENT - t_ 15056052059 s'd°2 15056052059 J RE1F1600 EX Pegs 3 FMS Nlenber ~eCedeAlt'S Complete Addrestf: 21 03 727 Gary D Henry DEC®alrs t~CIAI t;EglRrrr txi~ y-rt~rAt~ss 202-32-4365 60 Center Sdr~eet CfTY Carlisle STATE Zp Pa 17013 Tax Payments and Credits: 1. Tax Dus (Page 2 Line 19) 2. CrodAalPaymenls A Spousal Poverty Credit B. Prior Peyrnerda C. Discdert Toiel Credits (A+ B + C ) a intsresflPenaAy q appfx~ble D. Interest E. PeneNy 4. ff Line 2 is greabr then line 1 + line 3, enbr the dNfererroe. This is the p4f8lPAyAENT. InYraWPeraAy (D + E ) FlU in oval en Paps 2, Lirrs ZO b ngtrsst a rNtatd. 5. fl Line 1 + Line 3 fa greeter tlwr Line 2, errler the dfAererrce. This k the TAX DUE A. Etrter the interest on the tax due. B. Erder the toml of line 5 + 5A. This is the 6AlJ1tICE DIIE (1) 883.59 (2) (3) (ay (~ (~ (~) Make Check Payable t'0: REC~STER OF WILLS, AGENT PLEASE ANSVYER THE FOLLOYYNrG (KJESTIONS BY PU1CNtKs' AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent melds a transfer and: y~ ~ a. retain the use «inoarre of the property transfer-ed :.......................................................................................... b. retain the right to deeigrrrde vrho shell use tlw property transferred «ib hroorne: ........................_.................. ^ c. remin a -ever~onary «._ ...................................................................................................................... CJ d. receive the promise for Ate of edAer peynrenls, benePoa «care? ...................................................................... ^ 2. U deaU~ ccaered etYer t>eCerrber 12.1982, tAd deoedad trara6er properly wiUrin one year of death witlra,t rxerving adequate carreideretion9 .............................................................................................................. ^ 3. Did decederd own an 9n 6us< for' «payeble upon death berrlc eooourt «aecurily at his «her death? .............. ^ 4. Did deoederd own an Individual Relierrrerrt Accatsrl annuAy, «ofher non~probab propeAy wlMt4r oadains a beneflCialy desiprredon? ........................................................................................................................ © ^ fF THE ANSiNER TO ANY OF THE ABOVE QUES'T10N3 L4 YES, YOU MU)3T COMPLETE St~IEDIAE 6 AND FlLE R AS PART OF TF~ RETURN. F« dates of death on «alter July 1.1994 and before Jaratery 1,1995, the fax rate irrrposed on the net value of transfers to «f« the use of the aurvivirtg spouse is Utree (3i percent [12 P.S. §9116 (a) (1.1) (i)]. F« dates of death on «aftx Jarturey 1, 199.5, the tax nrte imposed an Ute rtet value of tansfers to «for the use of the strvivirtg spouse is zero (0) percent [72 P.S. §9118 (a) (1.1) r)]. The statute a d'anarer to a survivig spouse from lax, and the statutory requirenrerrts for dardosura of assets and fiAng a tax return are sbU applicable ev~nd tfte surviving spouse is the only benelit~y. F« dates of death an «aUer July 1,2000: The tax rate Ynpgsed an Ure net value of iransfers ttorrr a deceased dtAd M~erdy-otte years of age gr ygurrper at d~lh to «t« the use of a natwaf paront, an adoptive preerd, «a stepparent of the d>ild is zero (0) percent (72 P.S. §9116(a)(1.2)). The tax rate imposed on Ute net value of tret~ers tg a for Use use of the decedent's lineal bertefir9eries is four and one-heft (4.5) percent, except as noted in 72 P.S. §9118(1.2) [72 P.S. §9118(aK1)]. The tax rate imposed on the net value of transfers to «f« the use of the deceder-Ys siblings is twelve (12) percent [!2 P.S. §9118(a)(1.3)]. Asbling is def+rted, under Section 9102, as ~ individual who has at least one parent in oomr-art with the decedent, whether by blood «adoption. REV-1508 IX+ te.ee) COMMONWEALTH OF FEHWS`lWANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ ~••~~ Gary D. Henry ~~~~ ~~ p~p~~I~N~C~~D~~E~POSRS~ 8t MISC.. 21-03-727 kldude the poceede of end !n date the preoeede were neeehrsd M the amts. ~ orowrW lid rth ~ a - ~ a dt.etoe.d on tta»rwe ~. DATE 1 PayroN Check il8588, Rose Metal Inc. 2 PayroA Check 1)!8622, Rose Metal Inc. 4 1994 GMC Seirra K1500, Pick Up Tnx:k, VIN 1GTEK14K4RZS23001 5 2003 Carry On, Trader, VIN 4YMUL06103V021850 6 Ruger New Model Blackhawk, .41 magnum, Handgun, serial #47.00226 7 Federal Incorrte Tax 2003, tax rettxld TOTAL (Abo enter on dne 5. Reapihdedon) i (s more epees is needed, Ilgerl adlAtlond sham d the same aixe) 359.34 428.32 5,000.00 580.00 400.00 1,201.00 7,968.86 a~. ~ ~ , . S '~ ~ ". ~~= ~ ~, z '° x ~ ~ .~ ~ ~~ a s x s~ z z gooo~ p p f~/1 h O O O O 'JD ~ N O ~ o0 N O. O W S O S O No O~ W N ~ O. w ~ ~' ~ W W Oo N r.~ lh ..-. O N N ~p W W J ~ O O A 1~ y ~ rov,pnroro~~ro ~~ ~aaa$~8. ,.+ N c r ~10 ~~ a~ ~ ~ o d ~~ ~ ~ f c ~ ~ ~ n x .l .r O~ .. ~ Q~ w O~ _ ~ O J O V' O O~ Oo O+ ~d ~ oo _ O~ O N N J w :0 ~ S N N N N 0o 0O - N _ _ o ~ N W 00 J i~ V .- v. v C O iT O O i+ ~-' w a ~+' A S N Q r A A O V CST t~ r~ zo ~ Vi A '~ z z z z y y ~ N ,/~ r .Q Np A O O J Oo O a r rn~ C A V N N V W 00 N w o ~ o ~. ~~~K ~~~ A O O CA °o $$$ W N ~ O pO O O S O 00 wo'-~~ s w~.~~ppaw C O A ~ n ~ ~ ~ ^. t7 ~N~ x ~ ~ ~ n w, o~ ,pp in pO oe. O -w~p ~.Y O N O T S b O A. N Oo J N N Obi N O N -' G1 :`~ ~..J. S J O VNiN A Jb-~ ', DBCSASBD ~~ DepartrrlerttotlheTreasury- IniernelRevenueService 1040A U.S. Individual Income Tax Return ae) 2003 Label (Ssepagels~ GARY D H$NRY -DECBASBD 8/1 1 /2003 'k BRIAN R HENRY ~'°~ 46 MOIINTAIN VIEW TERRACE -RSwrai. NgWVILLE, PA 17241 Otherwise, please print ortype. PnddeMld p~yon' No1e.Cheddng'Yes'wRnotdtangeyourtaxorreduceyourrefund. c ~~: (1) f9rst name Last name (?)Dependent's sotBai securely number (3) Dependem's re~tlonshipto YOU d qwl, eniafor nlw taz cr. hee Pp ~) - - - ~. ... vvw a yaw a n renum, warn is W O W VlielUnC7 - Yee NO Yee P1O Fling 1 $ Single 4 Head olhOUSahokf (wish 4udHYin9 P~oN• (See page2OJ Statute 2 Msrrled f8ing)ohtBy (even itonyone had income) , If the qudkyirg person is achiltl but not your tlepsndera, enter this Check On y Married filing separately. Enter apolae's SSN abovaSfull rwme below. ~hild's rwnshsre.- one box. t - 5 1 ~ I OualHying wklow(ed with dependent t~lNd (See Pape 21 ) Exemptlons ~ U YourseH, tlyourparent(orsomeoneeise)cancldmyouasa N e. of bo:ss dependentonhisorhertaxretum,donotdteckbox6a. ~ seo deb°" b ~ Daps No. of ch iltl nn on ee who: if more B1an SIX depender>is, see page 21. •IWetl with you •dld not Ins wkh youtlue to d Worce or upwation has pate 23) ospentlenta on Qo not entered above Add numbers on linos Income 7 _ wages, salaries, Bps, etc. 7 9 1 1 7 Attach FormWW-2 ~ ~ ea TaxabkinteraetAttachScheduleli(requked. 8a n' o atfadt b Ta>tiszemplinterest.DonotintBudeonine8a. 8b Form(s) 9a Ordinarydlvidends.AtmdtScheduleliimquked. - ga 1099- R Htax b QudlBed dividends (see page 25J 9b waswithheld. tOa Capilal9dndistributbns(seepage25). 1Oa b Post- AAay 5 capital Salo distributions fees page 25) 10b ~- k youdi0 nos 11a IRA yet a w• z, see distributions, t to PeOe zc. 12a Pertstons and Enclose, outdo annufBes. 12a not attach, any payment. IRS Use Only - D o not w rke or ataplo in this spas. Your sodd security number 206-32-4365 Spouse's sold security number ~ impor=antl ~ You mustenteryour SSN(s) above. You Spouse 12b 14a Socldsecuriy tIb Taxableamount benefits. 14a r~..e..., not ... 15 Addlk-es7lhroughl4b(farrlghtcolumn).Thisfsyouraotalinoome - 15 15 014 Adlus~d 1A Educatorexpensee(seePage28). 16 9rOSS 17 IRAdeducBOn(seePage28). 17 inf`Ome 18 Studentk>mlinterestdeducUon(seepage3l). 18 19 Tuition and teesdeduaan(ssepaBe31). 19 Z4 Add Tines 161hrough 19. Thewareyourtotal ad)tatnurrtr. 20 21 Subtractline2OfrombtelS.Thisisyouradluabdgrcasincome - 21 15 014 KBA For Dladosurs, PMvaey Aot, end Paperwork Redudlar ActtMotke, ass page 57. Form tO~OA (2003) 71b Taxableamount (sea page 25). t2b Taxable amount Tax, credits, and payments SLendard Daduotlon for - • Peoplewho cheated any boxonNne 23aor23b or who can be claimed as a dependent, see page 32. • All others: Slnyia or M arrled tiling uperatey, s+,~so Married f ilinp ]o1ntN onnrpp widow(er). Se,600 Head oT household, '~ =7.000 23s Check i(: b B u a. You were bom before January2,1939, Blend Total bones SpousswasbombetoreJanuary2,1939, Blind}clratd0ed - 23a ^ y0 v.n~.,Doom.HOeF~+~~1~y[furBPOUSeIBBI111Ze8 _- deductlons,seePage32andCtteckhere . ~, ~"'~ 24 ErmeryoursWldsrddsduatlon(SeeleitmeminL 2B Munipys3,p5pbythetotalnumbwoFexamptbnsdaimad on NneBd ~ v ~ v ~ . 2s 3 050 27 3ublrsctline26tromline25.BIne28~morethanfine25,ether-0-, ------ --• - 27 7 214. 28 Tax, Inl3uding any altemaflve minimum tax (see Dane 29 Creditforchidanddependemcaresxpenses. rage. Attach Sdtedub 2. ~ 30 CredRiortheeldeilyorlhedisabied.Attach Schedule 3. ~ 31 Educaflon Credits. Aitatth Form 9863. 31 32 Retlrem~tsa~ringsudonscxedit.Attach Form 8880' 32 5 8 . 33 Chlld tax cxedft (See Page 37). ~ 34 Adoptbn Credit. Attach Form8838. - 34 35 AddBnes29through34.Theseareyourtofalasdib, 35 58 3A SubtractiMe35irombte28.HINte35ismorethanNne28 ertt~-0- 37 , AdvanceeamedincomecreditpsymentsiromForm(S)W-2 . 36 676. 37 38 Add Imes 36 and 37. This is yourtortal tax, - 39 6 7 6 3Y FederelincometexwifhhaldlranFOrmsW-2 and 1089. 38 1 8 7 7 . 40 2003esdmaledtaxpaymertisandamarM H yvu have aPPbed from 2002 retttm. 40 aquaRyittg 41 EarnsdlnoomecrodR(pC), 41 tthild,ettacl) 42 Additlonalchgdtaxcredk.AtlachFOtm8812. qZ Schedule E1C. 43 Add Nnes 39through 42. These are yoiutotN paymsnte. - 43 1,877 Refund 44 8Nne43iemorethanNne38,~btractline~tromYne43. This istheamountyouowrpsid. 44 1 , 201 Dq~t 45a Amount of Iine 44 you want rsfundsd fio you, - 45a 1 , 2 O 1 depOSrt? - b Routln andflll~io ~ number %XXXXRXXXXXX$XXX - c 7ype:^ t> ~ ~ ~+`b, 45c, - d Account and 45d. number XXXXXXXXXXXX%X%XXXXXXXXXXXXX Dun a youw toyour 2004 estimated mx. .~ /hrrWUnt 47 Amountyouot+re.Subtractline43fipm~e38.FordethHsonhow you OWe t0 Pay, See Page 51. - 47 48 tsflmated tax (see 521. qg - Th1rd party Do you want to aNO~v another person to discwsstttie rewm with the IRS (see page bTJ7 Yes. Complete the following. X No ' deal nee g Designee s name Phone no. PersonallDnumber slaw,~n •!I here _ - (PIDB- (- Under perwtlu oT ppwesjury, I dacha that I haw eaerglnsd Mis return and accompenyirg achadulu ana statements, and to the but of my knowledge erW hNiM, they efe triN. correct, Yid aecuratafy eat ee Ynounts aM sOU/cYS of income I ncsived during the tan yses. Declaration of prepares(otMrthanthetaxpayes)h Daaed onall informaYan of which the h prepres es>rry knowledge. Jointretum? Seepage20. Yoursignature Date Youraxiupa)ion DayHmephonenumbw Keep acopy SCSASSD foryour SPou~'ssignaiure.gajointretum,bothmustsign. Dabs Spouse'soccupalbn records. Paid ' ~ acres' '° ~. De ee ~ g X $ 3 0 preparer s 2 19 2 00 s em b 19 6 2 6 70 use only enema or ,g AND R BLOCK yoursHael(-employed), EIN 25-1769631 Form 1040A (2003) REV-1510 EX+ (e-ee colAfroNVU~,Ini of PENNSnvANw INHERRANCE TAX RETIXtN RESIDENT DECEDENT ~~~~ INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY ESTATE OF fiLE NIII~ER Gary D. Henry 21-03-727 This edierMle mrRt 6e caertileled end INd B the eraew b wry of quegiont 1 tMarph 4 an iM rewee elde d the REWiS00 COVER SHEET ie Yse. f(ELI _ DESCRIPTION OF PROPERTY NnuoEn~wwEaFn+~t,n+ertrooec®ertwo n~o~veaFm~uara.aua+~cawaFnEO~noRrc~ DATE OF DEATH VALUEOFASSET %OFDECDS WTERESt EXCLUSION TAXABLE VALUE t • Saldder Trust Company, IRA, Transfer date 10J1512003 to Brian K. Henry, 23.204.16 100 20 204 16 Son, Ctristopller D. Henry, Son, and Stacey L Rupp, Daughter. , . 2 Oppenheimer Funds, Simple IRA, Transfer date 09I10C1003 to Blinn K 1.710.07 100 0 00 Henry, Son, Christopher D. Hemy, San, and Stacey 1. Rupp, Daughter . TOTAL (Also eater on line 7 Recapiertalion) f I 20,204.46 (R more epeoe ie needed. Yreert addWOnel eheete of the same size) Account Statement January 1 -September 30, 2003 ~~ ramww roam as m ~ ors uvr s~ea~ ~~ w~a-Aeeounirs 1•~tket Value as of 12/31/02 htoonne 463-1333905813 Growth- GrrhA 03-133390581 3 Marken Value as of 09/30/03 a,aa.rt+~.yw~ wed-~~+~ Market Value as of 12/31/02 Cash Reserves 74-133390581-3 Cash Reserves 274-133390581-3 Market Value as oaf 09/30/03 l4oR~r~oNo Tot+el as of 09/30/03 2002-RetirementAccount Contributions: $0.00 2(103 Retirement Account Contributions: $0.00 SCUDDER INVESTMENTS ___ _ _ --3zr,44a.89 ---- $16,809,69 312.93 525.263: $6,791.65 8:09 :1,454.271 11,765.05 _ $18,556:70 sue. ~. x S tier., o~.a _ raw. X4,639.20 $i.00 4,646.410 $4,646.1 1.00 1351 1]35 $4,b47.76 $23,204.46, ~~~s~ws~w~re ' Oppenheit~~l=unds The Right Way tQ I~st I~~~IIL~~III~~~~~~ILdI~~~~lll~~,~.~IL~~~II~~~IL~I io.~ora~,atm,ctottra+au RPSS TR SiMlLE Nbis ROSE METAL tilg FOQ ~ D HiIINIf 000 NEIIMLLE RD CARLISLE PA 17013-1735 Account Statement Jenwry 1, 20&9 throa0h September S0, Y003 Pape 1 0l 4 Your Fb»aeMl AdNeer DWAYNE D KEtJ.ER, flNANCIAL NETWORK INVESTMENT CORP 201 GRANITE RUN DR STE 260 UINCASTER PA 17601-6824 71T-580~1M At Your 8eMa ww.~uodo.eam 24-hour automated service; 1-800-CALL OPP (225-5677) Repres~tatives available Mon. - Fri. 8 am - 9 pm ET and SaL 10 am - 4 pm ET (Jan. -Apr.) . Portfolio Summary January 1, 2003 through September 30, 2003 RetlrenMt Po-dfo/b as ar orata "out r r u Oppenheimer Money Market Fund, Inc. ;335.95 +;214.85 -;552.85 +;2.05 0 00 ~ Aa;ouM Ot200 2000204814 . ~ Oppenheimer Equity Fund, Inc. Class 8 5639.95 +;376.00 -51,156.03 +;140.08 0 00 °s Account 0~421 4212144362 . ,y Oppenheimer Limited-term GovemmeM 5794.17 +5483.40 -51,280.49 +;2.92 0 00 Fund Class B . Atxount 0~856 8500978659 Tetai Retiremer-t Porllo0o ;1,770.07 +>;1,07426 ;fi,060.3T +;146.06 0.00 0 Total Portlollo Yslua >)<l.TlO,f +;1,07426 ~2,00l.S7 +;145.06 ®.00 ~ OppeeillNsrorfeeda News On selling your shares, you may pay a sales charge. for the charge and other fees, see the prospectus. /f you have recently changed your email address and are enrolled in eDocs Direr; our electronic delivery service of fund documents, be sure b update your email address with us. Just !M b www.oppenheimerfunds.com, log in with your user lD a-si password and click, 'Update Your Profile Now.' (Continued) REV-1511 EX+(12.98) SCMSI~tIL~ M oohtwaaweant of rtawsr~variA FtJWERAL EXPENSES 8 rwttteRrru~ Tnx Rer1n1N ADAAINMSTRATNE COSTS RESWBiT oEC~ar ~aTA~ ol= l~ Gary D. Henry 21-03-727 Dabea or depYeM ertae a epartad oe t3eAadaN L .~.. A. FUNERAL D(PENSES: t' Grave opening and t~sirtg, Curriberlartd Vafley Memorial z Vieltiittg, raslcet and funeral, Hoffman Rolh Funeral l'lorrte s. ADMINISTRATNE COSTS: 1. Pertaiel Repsserraive's Comrriabru Name d Persaml Repreeeraatlre(a) Socid Sec1aNY Numbsr(syEIN Number of Persorrel RapraaanlaYse(a) Sbeet Address qty Slab Year(s) Carrrieeion Paid: 2. Aaonlay Fae6 3. Family Exsmptlon: (M deoedsd's address k not are same as daNrrKs, aaadr el~lerrefon) (zerrrnt Brian K. Henry Sbeet Addram 46 fiAt. veW Tsrracb aP city Nevwille sae Pa ~ 17241 RaYeorehip of Clebrlant b Deaden Son 4. Probate Fees 5. Aowudanl'a Faee B. Tax ReMan Preperer's Fees 7. TORAL (Also enter an Ifrte 9, RacaplNAaaon) I t (p moro +~ ~ needed, irreert addltlonal shear d the same size) 945.00 7,292.50 100.00 8,337.50 . , -_ _ ~ _ HaGR stock 30 S HANOVER 5T CARLISLE, PA Office. 37114 (717}283-5H68 Professional: ri000190 R H ROACH Client; GARY HEFd2Y Tax Preparation 100.00 Total 100.00 Cash Tendered 100.00 Change Due O.UU Employee No. 000190 Thank Ycxr for choosing HBJt slack fnr~ your tax services. 3i1j2004 11:50:13 AM 4527374 REV-1512 EX+ (12-08) Pennsylvania SCHEDULE I OEYAR7MENT OP REVENUE DEBT'S OF DECEDENT, INNdtITANff TAT( RETUIW MOR'~'~~E ~BZ~ES ~ LIENS RESwENr oecE[>ENr ca~w~c yr FILE NIIMlER Gary D. Henry 21-03-727 kaport dabb hiivnad hp tM don/ont prior to daalh that ramahad anpNd at tM data of death, lacladhn wralm6araad a~adiral araauec. Sr more spas ~ neeaea, maert aaomonal sheets of the same size. Detach along perforation. Return above portion with your payment in tlw enclosed envelope. ` Please make check or money oMer payable bo ALLSTATE. enters Insurance Collection Notice ~A~~S~fid1E_ ncelled Policy Number. 9 01 792822 04!03 ~,~ ~~ s~ ~~ ued To - Payment Ow RY D HENRY UPON RECEIPT NEWVILLE RD 2LISLE PA 17013-1735 Amount Dw = a~so nce//ed Policy Description Agent And Telephone Number portanf lnfrornlation is our third and final notice regarding your outstanding balance. records indicate you owes 37.50. ase remit your payment for the entire amount in the enclosed envebpe. tt is our practice to send outstanding balances G_Collectioa.AgencS. __ __ __ _.----- ___ _. ----------- --- --. __ _ w have any questions, please contact your agent. - aaaa,r~,ra9orA~~ras,zoa~. o3oez~o ,a (OVER) i uestions about is bill? Please contact us by 30 at 1-800342-5 5 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allea6awn, PA 18104-9392 www.pph+veb.com Account Balance S 12731 E1CCtl7e KWH -Average Per Day Meter Readieg 1Bformation 1R Page 1 pp~ ~ ~- PPL Electric ~ soa7o-~so4i Utilities "~~~'" L+l~l This pan of your 15 bill helps you understand our 12 y electric use. 9 ~r~yy~ or MMer Readi : ngs 6 Actual ~ 3 Estimated 0 Customer 2002 JJAS Months 2003 eter .7~'-" Sep 9 Actual 664 Au 8 ctual 134 The graph shows the average number of KWH you used each day. You used 530 KWH to 32, days, or an average of 16 KWl- a day. The average daily temperature for your are: last monll- was 74F. Other impt-rlsnt i»[ormation on Iwck ~ c~ .. ~B~k 6AAY D F~HI.tY 60 CENTBR STREET CARLISLE PA 17013 ~~A 100 Sonata AYafwe ~~957-000417011 Page 1 of 1 ~~ ncootnrr No. -- -- - vwvraa~v - - - ~v rawer a.aaa+a ACCOUNT NUI~ER 053616?091 -- -- .-----------.---_. -- ___-- _ _ __ _ _ PREVIOUS STATSI~NT BALANCE AS OF 08/26/03 ........................ 35.3?- PLUS 2 DEPOSITS AND OTSER CREDITS ................... 35.37 LE93 0 CBEClCS AND OTHER DEBiT$ .............. .00 CURRENT STATEIQCLiT BAI.i1NCE AS 03' 09/26/03 .................... .00 NU!®ER OF DAYS IN THIS STATEI~LiT PERIOD ~31~ *** CHECPfI14(i ACCOUNT TRANSACTIONS +++ DATE DESCRIPTION DEBIT3 CREDITS 09/12 CREDIT DHrJlD 35.00 09/15 CREDIT ~HE11O .37 ~** BALANCE BY DATE *** 08/26 35.37- 09/12 .37- 09/15 PAYER SAL ID NUl~ER TN'~'a'QRST PAID YEAR TO DATE 00 23-2324730 .48 105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is Illegal to duplicate this copy by photostat or photograph. Fee For this certi£cate, $2.00 A• ~..c.~ Local Registrar P 9449777 No. AUG 12 2003 , Date N100JMIWJr1 COMMONYYEALTN OF PelelSYLVMNIA • OePARTMENT OF NEALTH • VRAL REOOgDB '""'t CERTIFICATE OF DEATH V e~ /~~~~ (Coronet 1. Gary D $enry ..- Male `""'~_...._v ortatoeaNakrA. G•i.>•rl 206-32-4365 A r011Br Mr11.~•B+1.7 arrFr,dlQrr,J ., ugust 11,2003 •^• r• rarr 61 n.. Apr. 18, 1942 Portege,PA ,,,{,.,,^ ~„~„^ ~^ 1r"~^ ~r-g~ Cuabariand North Middleton 60 Canter Street +rwarr ~• ^ M ' r:~6r.r rr i ,iR wd White CC~1e ~ COnatrOCtiOR Q0. wC~ Ns^ oArw a pwmwrnnwiy 1a i 3a• .r ar,,nr,caay 60 Ck e tlaa I vorced D • n ar 1aeAe+ce 1f.r.r PA ae Carlisle, PA 17013 nr.^ 1...e. re s.r.rrr.,laq r.,.ar le (J~p~ rAwl+a Wm,.11/IOY+luiy,y +..~«a >~rian Henry t ~ ~ n ew Te r . Newville, PA 17241 arrbB^ ~ ~'"°"1en^ ~.•r.r/wmBrr^ o•w ^ Aug."~.5, 2003 Cerle 9 V nc 1 Memorial Carlisle, PA •17013 Nu r~rrrrrreB.rar,r .r,,,"~Ytli1d~'• ••Mnl,IerBr,, rrpwrrn rnsi.rrsw~, lisle PA ~ 7 1 ";:s rw•rwprwrrr °' p x. 7•r.'r.n .. ys~. n. B errw. rrrwrmn„vwr.ree P. Au et 11, 2003 w~' ~^ , Yeryarrr•rwr,llr cups.ere,. oonr«,wu.rea.rA•~a.ucn.arr.enwy.rrrrnr rmw rn + ~ .. ..: , ~ eti ~ wt rw. IAPYre•r. lerf e: ONrryryryrWOraresyb ~ 1°~'wre.ua.M ~ r °i eer rrrerarp-+ ~m wW«ix wi.ra.rn ro MiR da7017NAeA OFk Remote MI ~ rr`nr'u Duero ~e~ ~ rwr ~ ~ I 1r ielre wu r1Y0herf,LAe~ (M ABA ~ .. Alydae N1101170 .. OROeRNT ~GUBE ~ 0•R 1r) Nr.r ~~ ^ N01Y w ^ w w ^ r. ^ Aeeiare ^ M1+Mrgrrrlreen ^ w ^ w ^ ~ ee-. s~ ^ o.eeere•err„rre ^ 6rsa.r~ •b"'' >ew 'rOi1tl01x°Bb' IBee~ rru ~ ww.wr,r~~'~".rn.°"~'ee..~.em°W:.arw~"a"r°"raAryrirro.e~.~ran.n.moo~,w.,.•zw aiwplrr.rwrr+erY ............................................ n ^ • ......... ~ r` Corone A~ rr.ree•~ewuwiw.rnawir~nb01ips°~are,.nawa~tgrar..tlarq Brr.r••rM/rw.rMMMM er~yrrrwr.rwr ~ 4 ~ .......................... _ 4 ^ AL 8t 2 20a3 ~B rr~ errwrr~yL ..............~'M""O~0^•die1O001'~'bMpw e•r, aer, r,eere,,r,sewr,ar m~0 Micha~i~L~. ~N~orris Coroner r r, ......... ......................................!!!~!!hl •ee •~~~~' ~,r . 6375 Haeehore Road. Su to /1`:~. J°~t M ~ echanicsburg, Pa. 170 ..~ ~,~ p< 15056051058 REV-1 SOO ~ c~> „~~Y PA Deparhllslt d 2eoe1 T°' INNERRANCE TAX RETURN ~ Cade 03 72 -irrlwuN• PA 1712s•oeN1 RE8IDENT DECEDENT ENTER DECEDENT Nr1FORMATN]N BELOW Sodet SecuAty Number Dots o(Death Date of BirSl 202-32-4365 08/11/2003 04!18/1942 Decedent's Last Name 8uISx Decedents Fk~ Name MI Henry Gary D (ff Applicable) Enbr SuMv(np Spouse's Mlbnragon Below Spouse's Last Name Sullbc Spouse's First Name MI Spouse's Soda) Sassily Number tins RsT~uRN west ee FAD N ounucAte wmi rnE REGISTER OF WILLS FNl IN APPROPRUITE OPALS BEiLOW ~ ~ 1. Oripind Re41m ~_~. 2.3uppbmsrrbl Rstum .,.... 3. RernaRWar Realm (dab d deeSl prior to 12-13$2) 4. Limibd Eebte =---' 4e. Fuhsa hltaraat Comprombe (dab d ":~ : 5. Federal Eabte Tax Rstum Regrdred dean alter 1a-122) S. DeosderK bbd Teelab ,..... r.... (Attach Copy d VYiN) 7. DscecbrK Mahbined a LiNnD Tent 8. Total Number d Selo Dapwk t3oxee (ASarat Copy d Tent) ..:? 9. LNtgetlon Proceeds ReoeiMed _~.' 10. Spouwl Panrty CrsrNt (deb d death ....~ 11. Election to tax under Sec. 8113(A) Helween 121 91 and 1-1-9ti) (Attach Sch. O) CORRESPONDENT - TINS SECTION WlST BE COMPLETER ALL ~ AND CONRppITN1l. TAX INPOWY1TpN 81I0111.D SE DIRECTED T0: Name Daytime Tebphorle Number etian K. Henry (717) 776.6462 r,,, Flan Name (N AppNcable) {'~ '~ REGISTE~OF~LLS USE ~Y ? ~ 7p t:!.:, r ~ Fast Nne d address ~ i _ U r' f V r'r"'' ~~' ~ ~ 46 Mt. verir Terrace U Q~ :r~ C7 ~-, 7 . ~ U, X ,- - 4 Sewrxi Nne d address C ~G-n ~ -:. c'7 _ ?~ z ~ ~ {ten City Or Post OSice State ZIP Code DAtgFILED ~ Newviile Pa 17241 Correapondertts a-Inell addreae: SNXa6tOf~8a.0Drt1 lhrdar PerrMiea d pequrx 1 dadrs art 1 haw pwmNwd tlas rsherr. kldudMN aeoomprrykip ecMdulas and a0sbrrnras, and b Ur trot d my WroMMdpe end trNeL N b true. and Wmpbla. dlrr then 11n QaraaW raprawrgAWa N baasd on aN erbrrrlleNorr d vddch PreDerar has arry InroMAedpe, 3 OF PERSON F FILING RETURN Dpi a 3-~-sold SN3NATURE OF F'REPARER OTHER THAN REPRESENTATIVE DATE ADDRESS -- t•LBAfE lN>~ ONLY 1 505605 1 058 Sites 1 ' 15056051058 15056052059 REV-1500 EX DeoedenYs Socid Segaity Nund~er '• -r•~e: Gary D Henry 202-32-4365 RECAPITULATION _.__.___ , ._ .._ _. __ ._,___._ _.___... _. 1. Real estate (schedule A) ............................................ . 1. 0.00 2. Stodrs and Batas (SdrediAe B) ...................................... . 2. 0.00 3. Closely Held Corpastlon, Partr~erslap a Sole~PropriebraNp (sr9radrle C) .... . 3. 0.00 4. Matgapes & Notes Receivable (3dredrrle D) ............................ . 4. 0.00 5. Cash. Bank Deposits 6 ~ personal Property (scfradule E) ....... . 5. 7,968.66 8. Jointly Owned Property (Sdtedule F) ::=a separaee Bilirp Requested ....... 8. 0.00 7. Infer-Vhros Trar~sFara 8 AAtsoeMeneous Hon.probap property (sa~eare c> ~ ~~.r seperete Biling Requested........ 7. 20,204.46 8. Total Orosa Aepts (total Ltrise 1-7) .................................... .._u_._~ ..__._.._ .._....__._... 8. ,..~._... 28,173.12 9. Funeral Experroea & Administratlre Casts (Sclredrle H) ..................... 9. 8,337.50 to. Debts of Decederd, 9e t.iabatles, a l.lerrs (ScAedule l> ................ 10. 200.18 11. Total Dedrwtlorrs (total Lkres 9 & 10) ................................... 11. 8,537.88 12. Net Vakre of Estate (lJne 8 n~irxrs Ltrre 11) .............................. t2. 19,635.44 13. CheriW>fe and Goverrsrrentd Bequestslgec 9113 Tnre~ for whk:h an ebctlon b ~x tree not been made (schedule J) ........................ 13. 0.00 14. Net lhlus SutrJset to Tsx (l.are 12 mkws Lkie 13) ........................ _ _. _~,.__._..__._.~ ____~__ _ _-- - - 14. 19,635.44 __._.. e _ w _ AX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Miourd of lJne 14 bumble at the epouasl tax rate, or transfers urWer Sec. 9118 (ax1.2) X .0_ 15. 18. Amaxd of Line 14 taxable at lined rate x .o ~ ts. 883.59 17. Mount of Ltrre 1418xahle et slblYrg rate X .12 17. 1 B. Amount of lJne 14 taxable a< coMaterd rye X .15 18. 19. TAX DUE ......................................................... 19. 883.59 20. FILL IN THE OVAL IF YOU ARE REpUESTINO A REFlNID OF AN OVERPAYMENT 15056052059 Side 2 L` 15056052059 • REV-1500 EX Pegs 3 Decedent's complete address: IhMMMr 21 03 727 ~rY D Henry _ oECr~rrr~ssocuLSECttturrtR ~~ 202-32-4365 80 Center Street cm sTaTe ~ Carlisle Pa 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 18) 2 CredNdPayrnenls a spousal Poverty C-edt B. Prior Payments C. Discgstt Tofel Credos (A+ B + C ) 3. IMeresUPertaMy ~ applcable D. Interest E. PAY 4. M Litte 2 is greeter Mien Line 1 + Line 3, enter the dNbrertoe. Thi6 fe the OVERPAYIENT. ~ (D + E ) FlN b ovtl en Ppe 2, LJrte t9 b regrreet a rNlund. 5. M Line 1 + Line 3 is greeter Mtan Line 2, enter Mre dN(eretae. This ie me TAX DUE. A Enter the iraerest an Mre tax due. B. F_nlar Mie lo4al ~ Line 5 +50. This is Mre BALANCE DUE. (1) (2) (3) (4) (~ (5n) (~) 883.59 Make Chedf Payable to: REGISTER Of WILLS, AGENT ~~ ~ ~ - , . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "l(" IN THE APPROPRIATE BLOCKS 1. Did decedent make a trarrefer and: ~ ~ a retain Mte use or rttoorrrre of Mte properly trarremrred :.......................................................................................... ^ b. ran the right to dedgrreie who dleN uee the properly traneferrod or ib irroonre : ........................................ .... ^ c. retain a reversionary Ytb-est ar._ ....................................................................................................................... ^ d. reoeire the pronree for He of eiBter payments, berrellle or care9 ...................................................................... ^ 2. M deem ooaxrod sl0er Deoernber 12.1982, dxl deoederd trarrefer properly wiMrn one year of death x~iMrotd roceivirtg aderrtrab ooraiderabon? .............................................................................................................. ^ 3. Did decederd own an 9n trust for ar payabb tpon death tterrlc aoooud or aaaxigr at hfa or her seam? .............. ^ 4. Did deoederd own en Irxlividual RBBrenrent ACOOttnt, amWty, or omer ttat fxobete property which oontairs a berleficiay desiprre9on? ........................................................................................................................ © ^ ~ THE ANSWER TO ANY OF Tl1E ABOVE QUESTIONS IS YES, YOU MIST COMPLETE SCFIEDIH,E G AND RLE iT AS PART OF THE RETURN. Far dates of deem an ar sitar July 1,1994 and before January 1,1995, tfte tax rate irtNxtsed at Mte rte value of transfers b or for Mte use ~ the attrviWng spouse is three (3) percent [72 P.S. §9118 (a) (1.1) ()). Far dates of death on or alter Jam' 1, 1885, the fax rata Imposed on tfte net value of dartsfers b or for the use of the sltrvivirrg spouse is zero (0) percent [72 P.8. §9118 (a) (1.1) (a)]. The stahde ~.~.9>f~lf8 a transfer b a surviving spouse from tax, and the statukxy regltYenrertla for drsdoeure of easels and f~i-tg a tax retrarr are a81 applicable even if the surviving spouse is Mte only bertafidary. Far dates of death an or after Juy 1,2000: The tax rate intpoeed on Mte net value of irartefers from a deceased drikl M~anty-wre yws of age or younger at death b ar for 1ha rate of a natural parerd, ~ adoptive parent, ar a stepparent of the dMd is zero (0) percent 172 P.S. §9118(ax1.2)]. The tax rate imposed on the net vaNte of trar~ers b a for the use of the decedents latest bertefiriertes k four and one-half (4.5) perixatt, except as rated in 72 P.S. J~118(12) [72 P.S. §911B(a)[1)J. The tax rata imposed on the rtet value of transfers b or for the use of the decedent's sibNrgs is twehre {12) pecent 172 P.S. §9118(a)(1.3)]. AsiaNig isdefined, under Section 9102, as an individual who Etas at least one parent in consrrort wi9r the decedent, whether by blood or adoption. REk1509 EX+ (B-99) COMMONWEALTH OF PENNSYlVAN1A INHERITANCE TAX RETURN RESIDENT DECEDENT sCM~p11LE CASH, B~-I~NC DEPOSITS, 8r MISC. PERSONAL PROPERTY ESTATE OF ~ Gary D. Henry __ 21-03.727 bdude tlk peCeede d Nlpral and eN dre Mie proaMla were raeeAled AY tlia aWle. ~ PAY Ielatl>Fowwad MIA r10ht of amvlrerahlp swat a dNsloNd on EeAaduM F. 1 PapoN Check if8588, Rose Metal Inc. 2 PayroN Check iP8B22, Rose Metal Inc. 4 1894 GMC Seim K1500, Pick UP Tnx~t, VIN 1GtEK14K4RZ523001 5 2003 Carry On, trailer, VIN 4YMUL06103V021850 6 Ruger New Model Blackhawlc, .41 magnum, Nandglrn, serial #47-00228 7 Federal IrXxxne Tax 2003, tax refund TOTAL (AAw enter on ine 5, RecapfAdetfon) i (s mo-e epaoe k Meded, Naert addWonr rroeb a sie creme sire) 359.34 428.32 5,000.00 580.00 400.00 1,201.00 7,968.86 -- --- - <, g o ~. 0 W i ~~~ ` ~ ~ ~ ~ x '° o ; ~ , ~ y a s ~ 70 n o n go p ~ po y y S 0 0 0 ~ to bO N O ~ o0 N O.O w S S O N W N .b ~ W 01 W J _ W ~ O N N tN b. W W v ~ O O A A oQQ ~ n ~ ~+ S d ~ ~~~!! y O G q ~ x A H m r W M ~ w a b O O~ 00 O~ a pp O a O p O° J w O S m ' i N N p c O N N Q~ N ~ N °O - N O N N ~ N ^' ~ O O~ O O A '-' '+' ~ V' ? O N O `t 'V A A N C1 es O V A -' O ~: 1 ~o go ~ ~ ~. . a ~~~ x o .J y a 77 a 7d x x ' o o o ~ na y y pp pp pp p~ 0 O ,p/ U Ji ~-' A N a $ o _ _ 4 o $ ~ o 00 O W N, ~ A 00 O yCj p~Jpp Aw ~ O O A A r r -+ O c ~ ~ ~ ~ ~ C ~ ~ n ~o 0 ... W N w-.~ ~ Ain 0000 w~O.N g ag~po `~ ~'-oho 0 0 00 U O0. .(~ N W _ . . ~ W pp ..- to N N N OO A ~ ~ . ~ J ~ ~ N ..~7. - G1 . p~ N Op S. J O VNiN A J b~ DECEASED O~IR c DspenrNrttr; (1) Fkst name last name t2) DependenYS SOCIeI security number (3) Dependem's relflUOnSllip ~ you neat child for h utl tas er. bas pp 23) ~) 2003 Label (ssepagels.) GARY D HENRY -DECEASED 8/1 1 /2003 ~ BRIAN IC HENRY ~~° 46 MOUNTAIN VIEW TERRACE IRSlabel. NEWVILLE, PA 17241 Otherwise, please print ortype. Praaide~l Note.Chet~Ckl 'Yes'wsnoteh i9sctlonCampsign' 9 angeyourtaxorreducsyourretund. d Flling 1 $ Sfilgle 4 ~1I ia.i LaV Ha®dofhousehold(wilhquatlyingPerson).(Seepage20J StBtu$ 2 Married lBm91otnily (even ilonyone had income) It thepuelNyiny personiasMild but not your tlspendard ernerthh Check ony 3 M uriad f ilinp separately. Erdsr spouse's SSN above 6 f ul1 name below. , child's rattne here. - one box. - 5 n pualiying widow(er) with dependent chill (See page 2, ) EXemptiOllS ~ U YouraaM. nyourparent(orsomeoneelse)t~nclakr)youasa No.otbo:ss dependent on his or hertax rearm, do nottiteck box Ga. } e;; wy 8 00 1 b 6 J No. of chiltlrsn On SCwho: ff more than SiX dopendenis, see Page 21. Income Atbtch i=ormtu w• z here. Aho attach Form(s) 1098- R Mtax lxaswithheld. 11 youtlitl not yet • w• 2, ass Pta• ze. Enclose, but tlo not attach, any . payment. elived wkh you etlid not IWe w Kh you d w to dWorq or separation bN papa 23) DeppssMenta on 6c not eMeretl above Atltl nwllbers on lines scow 7 Wages salaries, tips, etc. ~ 7 9, 1 1 7 8• Taxable Interest Attach St~tt3dule 1 N required, ~ b T~ axsmpt Interest Do notlndude on fine 8a 8b 9a Ord narydMdends.AtmcltSchedulelHrequked. ~ b Ouafifieddividends(~epage25J gb 108 CapitalgaindktlribulkMS(seePage25). 10a b Post-MayScapitalgaindlsslriibufions(seepage25) 106 11a IRA 116 Taxabktamlwnt (see Page 25). 126 Taxable amount 12a Pensions and Internal 12a iRS Use Onty - Do rwt wrke or stapN in this spaq. Youraodalsscuritynumber ---- 206-32-4365 Spouse's social setxrrky number . ImF70ri8f1ii . You mustertteryour SSN(s) above. You gpou~ 126 -- - m....w+w.ara~rwrrorurunattmoertns. 13 5 897. 14a Socielsecurily 146 Taxableamoum benefits. 14a (see a ~). 146 __ 15 Add tines 7lhrough 146 (tarrightcolumN.This isyourtoRal inooms - 15 1 5 01 4 Adjusted 18 EducatDrexpensas(seepage28). 16 gross i~ IRAdeduct,on(seepage28). n income 18 Studerttlo~tinterestdeducUOn(seepage3l). 18 19 TufUonandteeededucfion(s6epage3l). 19 YO Add Tines 161hrough 19.TheseareyourtoW ad)uslnrsnts 20 21 Subtractline20iromArtelS.ThisisyouradhutlMSroasirraortta - 21 15 014 KBA For Dkwloswe, Privacy Act, and Paperyrork Reductlan ActNotice, see papa 57. Form 1040A (2003) Tax, credits, and ~>~~ Standard Deduotlon 10f - • Peoplewho chedted any boxonAne 23aor23b or who can be f3a&tted as a dependent, see Page 32. • Ail others: Sinyfa or Married filirp wParatay, 51,750 Married f Ilinp joint1y of QuNRyinnpp waowgr), Se,6fr0 Mead of howehold. 57,000 -_]L- 23a Check You were bom balsa January2,1939, BAnd Total bo)oss ff: Spouse was bom before January2,1939, 8 BNnd }«»obsd - 23a a b ff you ere married 1Sng separaffiy and yourspoufte itemizes deductlone, see page 32 and check here - 23b n 24 EntaryouratalldarddsdYCtlohGi9eleltmaminl- ~ MusPNi3,050bythetot~numbaro(eraempik)nacleimedonNneBd ~ v ~o~. ~ 3,050 27 Subtract Nne26iromI~e25.fffne26ismorethanlme25.enffir-p-. 29 CredkiorchAdanddeperMeMcareexpenses. Atffictt Sdtedule 2. ~ 30 Credkfortheeklerlyorffiedisabled.Attach Schedule 3. ~ 31 Education credits. Attach Form 8883. 31 32 Retiremf;trdsavingsfx>rrtribudonscredk.Attach Form t~eeo. 32 5 8 . 33 Child tax credk fees Page 37). ~ 34 Adoptron wepit Attach Form 8839 34 35 AddAnes29through34.TheseareyourlDotalpedita, ffyou have dQildatrachg Scheduffi EIC. 38 SublrectAne35iroml~e28.kYne35lsmorathanyne28,efner_p.. 37 Advanceeemed~comecredkpttymenffitromFOrm(s)W-2 38 Add Ones 36 end 37. This iB YDUrtlDtaltax. - 9Y FederellncomelaxwkhheldiromFormsW-2 ~1~' ~ 1 877. 40 2003 eadmaiad tax paymems and amount aPPAed from 2002 retum. 40 41 EarnedkroomeoradRgaC). 41 IY Addkional dtNd tax credk. Attach Form 8812. q2 4S Add lines 391hrough 42. These are yourtiotal payments. ~ Refund ~ ffA"e~~morethanAne38,subinfctAn~38irOm~e43. Direct deposit? aztd till~fn ~ asb,4sc, and 45d. 45a as - b Routing number XXR%RX7C%XJCX%XRRR - c 7ype:Q adAadlo~ ~ ~ - d Accoum number ]C%]CXXXXXXYYYYYYYYYVIrvvvvvvvv 1 2004estlmsbdlax. ,~ AIrWUnt 47 ~oanlyouowe.Subtr~tAne43irombte38.FOrdetagsonhow ytw OW@ to PaY, see Page 51. - 47 4a Estlmated tax penaky (see Dage STJ. ea Third party ~ you want to aAow another person b discuss this retum wkh the IRS (see page b2)? deSlgntSE Dedgnee s name Phone no. Yea. COmpktffithetollowing. (J No sawn under peratltNs of Dar)ury.l Oeelarethet I bare srzarnlrNd the return and eccompanyirg schedWM and statama cif knowletlpe eM beIIINN May are true, corraet, end axyptey bet W amaunb aq aowtea of income I recaWad d~ here of prapver(othsrthantftetaxpayer)h based onWinformation of which the prepvM has arty krgwledpe. Jojntretum? Yoursignshrre Date Youroccupation Seepage20. Keep acopy SCSASED for ur Spouse'srHgnalure.ffa ointreWm,bothmust yo j sign. Date Spouse'socx:trpatbn ramMr to the baq of my t~ year. Deelaretion Daytime phone number Paid si~nalures' ~ Daffi Chedtff Preparer's33NorP71N preparer's snante ~ - 2 19 200 sell-em b 196-30-2670 use only yoursffseff-empbyed),'~_~D_a BIrOCK ElN _25-1 769631 7R 7 Form 1WOA(2003) Ref/-1510 EX+ (wee col~-ttoNV~ALTH of PENNSYI.vANIA INHERITANCE TAX RETURN RESIDENT OECEDEKr ~~R-~~ ~w/y~.7r~1W 8t ESTATE OF FILE NIA~ER f3ary D. Henry 21-03-727 Thk adwdlie muel be comDlebd end filed H the arerer b rry al gtreeYone 1 ttwyh 4 an tre rswwe dde d the REY-1500 COVER 9ttEET k vee. ~1 DESCRIPTION OF PROPERTY ~a~+ee>~w~aFTMEErnertl~naarrooecwrt~uo nEaaeavm~wsscar~aemwocn+eoe~mal~r~uh. DJITEOFDEAIH VIILUEOFASSET %OFDECDS MrtERE5T E70CLUSION TAXABLE VALUE I • Saldder Trust Comparry, IRA. Trarrefer date tOM5J2003 to Brian K Henry , Son, D. Herey, Son, and Stsoey L Rupp, Daughter. 23.204.16 100 20,204.46 2 Oppenheimer Funds, Skrlple IRA, Trarlsier date OgM0/2003 to Brian K Homy, Son. Christopher D. Henry, San, and Stacey L Rupp, Daughter 1,770.07 100 0.00 TOTAL (Alto enbr on line 7 RecarpiWlation) ; I 20,204.46 (K more apace b needed. insert addtlonal etleete of dro tame elze) ccount Statement January 1 -September 30, 2003 SCUDDER INVESTMENTS Page 1 of 6 _ ~ F~ Qb'1' Seeiel r Nwnbrr Cn File [>.~RTt'.¢r~r PA 17013-1751. ahenl~oldrr i (800) 62i-1048 l arddKACtE3S ' `(800)972-3060 Intnnnt Addewf wwwscuddercom ~~~~~~~nr~~liuur~~n~~un~~~u~~r~~~nn~~~~~u~~m~u~~~ i-nMilAddnss infp~bCU~ELCOItl Year R~+nwMHvn GIBB MARLIN CADARE!' GRANT F~ CO INC GIBB FINANCUL SBIiVIC~S'IIdC 16 W POMFREI' ST GARLLSLE PA 17033-3216 ~+eutldsr M+rws See Scudder Reports newsletter --;enclosed with this account statement -- to learnmore-abo>zt the new tax law and Scudder funds that may help you take advantage of lower tag rates on capital gains and stock dividends. .,; PgrfipNo Spry ..,, ,~ F'~e~felb Totbi as of i 2i31 i0s - - _ -- _ -~zr>4~18.89 . ,. 3etradrr Fuads Rued-Aieovnt# 'Shari Prk~ ~[ .mss Owned Mqu#stYahir Marltet?Value as of 12/31/02. $16,809,69 Inoame 463-133390581-3 $1Z.~3 .525.263 S6>791.b5 ~r1O~ - GrthA 03-133390581 3 Market Value as of 09/30/03 8.09 .1,454.271 11;765.05 $1$,556.70 SeuddK Money Funds Fund-Aeeount# sham F+~iq x ' s Owned x Mat4tat Yarn Market Value as of 12/31/02 $4,639,20 '~ 74-133390581-3 $1:00 4,646.410 $4 41 64f Cash Reserves 274-133390581-3 1.00 1351 , . 1.35 Mai~et Value as of 09/30/03 ~>647.76 Portfo0o To1o1 as of 09/30/03 $23,204•.46 2002 Rettirecttent Account Contributions: $0.00 < 2003 Retltaement Account Contributions: $0.00 i.... ,' irwias~aswssss ' Oppenheir>~if`unds The Right Way to fet~t I-~~IIL~JIL~~-.-II--II--.-ill--.t,~lrti.~16---II-.-IL-I -o.aro~aa.sros~ctonraao RPSS TR StilLE 11r11 ROSE MEU1L >~iHlt ~ fti0 G71Rtf D N~f 906 NE'lli{flLLE RB CARLISLE PA 17013-1735 Account Statement Janwry 1, 200.1 through September S0, 2008 Pape 1 ~ 4 Vora FhaaelN AdNwr OWAYNE D KELLER, FINANCIAL NETWORK INVESTMENT CORP 201 GRANITE .RUN DR STE 260 LANCASTER PA 17601-6824 717.610.449! At Your Ssrvip srrrw~nde.eom 24-hour automated service; 1-800-CALL OPP (225-5677) Representativea available Mon. - Fri. 8 am - 9 pm ET and Sat. 10 am - 4 pm ET (Jan. -Apr.) . Portfolio Summary January 1.2003 through September 30, 2003 R1GIreslNwt Po-lYbr~o ss as ot~ y c -"~r a, vyyan.oxiss mussy ss~e[ rurro, rec. 1335.85 +$214.85 -6552.85 +62.05 0.00 Account #200 2000204814 Oppenheimer Equity Fund, Inc. Class B 6639.95 +6376.00 -61,156.03 +$140,p8 0.00 Account #421 4212144362 Oppenheimer Limited-Terre Government 6794.17 +6488.40 -61,280.49 +82.92 0.00 fund Class B Account #856 8560978659 Total RotiremeM Portfolio _ 61,770.07 +61.074.26 X2,119.67 +6146.05 0.00 Total Portfolio Yalw 61.7lt>~ +61.074.26 ,SZ,011.37 +;145.06 0.00 OppeabslororfaNda Nllt~d On selling your shares, you may pay a sales charge. For the charge and other fees, see the prospectus. If you have re~centty changed your email address and are enrolled in eDocs Direct, our electronic delivery service of fund documents, be sure to update your email address with us. Just ~o to www.oppenheimertunds.com, log In with your user 1D and password and clkk, 'Update Your Profile Now.' 0 H 0 s S to 0 (Continued) REk1511 l7(+ (12-99) COI~NIOrMVEALTH of PB~NSYIVANIA INttERITMICE TAX RET11FiN R(T pECEDp~If s~~ouu M s~ ADAAIPNSTRATIVE COSTS w m~~. yr Rc NlI1AER Gary D. Henry 21-03-727 Oeb1s a deadaat ewer a mporMd oe Salredri L ~. FuNERA1. ExPENSES: 1' Grace opeturtg and doting, Ctxrlberlartd Valey Memorial 2 Yiewirg, casket and 6pteral, Hotfmart Roth Funeral Home e. i ADMINISTRATIVE COSTS: 1. Panend RePrseerMwive's Carrrridons Wane of Paraabl Repreeer~fapye(a) Sodel SecvrNY Nrenber(ayEIN 1Nanber of P'ersaiel RapAeenppve(s) S6aet Addreae ~H S~ Year(s) Carnieeion Paid: 2. Albmey Feea 3. Famly Fxempliorc (p daoedanl'a addre~ i6 rat pie same a chirrad'a, epoch e~lenatlon) Brian K. Henry seeetAddeas 46 Mt. Yew Terrace ary Nevwille Siate Pa Reiadoieldp of deYnant b Decederd Son 4. Rabeb Fees 5. Accae~lanra Faso 6. Tax RMum PreDeraf's Fees 7. ~P ~P 17241 TOTAL (Also ernes on Nne 9, Recapihdeport) I i (p more spats b needed, tneeA addldoiW wheels of pie aana size) 945.00 7,292.50 100.00 8,337.50 iv _ _ ,wwa . ~, .,~.-.-~.....~-. . , - ~ H&R Block 30 S HANOUER ST CARLISLE, PA Office. 37114 (717}2q3-6868 Professional: #000190 R H ROACW Client: GARY HENRY Tax Preparation 100.00 Total 100,00 Cash Tendered 100,00 Change Due b.OU Employee No. 000190 Thank Yau far choosing Haut Block for your tax services. 3/1%2004 11:50:13 AM 4527374 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OP REVENUE INHERITANCE TAX RETURN RBIDENT oECEOExr ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES B LIENS FILE INN~1lElt Gary D. Henry 21-03-727 RMOtt ~ IROIIMA M Hlr d~M w~M~ M JWY f6N ....J~J ..~~u .a .~.. y._ v ~_~. ._~_~._ _ -- _ n mere space ui neeaeo~ IRSM S00RIUf181 SII!!tE Ot tllE 58Rk SIZE. Detach abng perforation. Return above portion with your payment in tM encbsed envelope. ' Please make check or money oMer payable b ALLSTATE. ~~nfers Insurance Collection Notice ncelled Policy Number. 9 0? 7?2822 04/03 ued To RY D HENRY NEWVILLE RD 2LISLE PA 17013-1735 nce//ed Po11cY Pin Agent And ~Aiis~fiate. Voute in good henda Payment Due UPON RECEIPT Amount Due : 37.iE Number portent /nfonnaflon 3 is our third and Bnai notice regarding your outstanding balance. -.records indicate you owe S 37.50. ase remit your payment for the entire amount in the enclosed envelope. :r-Cotlectk~a. Agency. _ _ _ -_ _ _._... _ ----- -- --..------___._ ~u have any questions, please oontaGt your agent. - K is our practice to send outstanding balances ~,>~~~~,,~~~ ~. ~~z~ ,8 (OVER) i PPL Electric Utilities Electric Service For: GARY Hl]VRY eo c>?rrrER sr CARLISLE PA 77073 uestions about t is bill? Please contact us by 30 at 1-800-342-5 5 or 484.634-4900 PPS Summary Page Balance as of seh !, Z96Li Page 1 ..~., 80470-75041 Charges• Total-YPL ELECTRIC UTILITIES Cbarges Total Charges Account Balance S 30.49 s 96.82 $12'7.31 S 12732 or write to: _ Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplweb.com Electric KwH -Average Per Day Meter Reading Information Use 'R This part of your 15 bill helpps you understand your 12 electric use. 9 T~yypes of Meter Readin s: g 6 Actual 3 Estimated 0 Customer [] 2002 JJAS Months 2003 er Sep 9 Actual 664 Aug 8 Actual __ 134 Th~__e ggraph shows the ave7a a number of KWH you used each day. You used 530 KWH to 32 days, or an average of 16 KWI- a day. The average flail temperature for your are: last monti- was 74F. Other imporlaet i>tfonuation on back ~ ~~/~/~ 1 ~~~ 100 San~Re A~ ~ Pa9'e 1 of 1 Bank ~ ~,,'~„ sTATr ~N M~ GARY D w 60 CENTER STREET CARLISLE PA 17013 AcoooaT go. CYCLE-011 ....~....~...-. - -- - vv rawu a.awa _.. - A000DNT NUMBER 0536167II91 __ _ .._____.~.~.,.____. _ -_- _ -_. _. PREVIOUS STATBIB<NT SALANCE AS OF 08/26/03 ...................... 35..37- PLVS 2 DEPOSITS AND OTHER CREDITS ................... ~~ 35.37 LESS 0 CHECLCS AND OTBER D88IT3 ....... .00 CURRENT STATEMENT BALANCE AS O? 09/26/03 ............... .00 NUMBER OE DAYS IN THIS STATE' PB}.tIOD .31 ..................... *** CHECPCINl3 ACCOUNT TRANSACTIONS +-** DATE DESCRIPTION DEBIT3 CREDITS 09/12 CREDIT MEMO 35.00 09/15 CREDIT MEMO .37 --*s,t BALANCE BY DATE •,-,r---------------------------------------------------- 08/26 35.37- 09/12 .37- 09/15 .00 PAYER FEDERAL ID l/UD18SR 23-2324730 INTER83T PAID YEAR TO DATE .48 I05.805 REV 9/66 • This ;s to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING:. It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9449777 No. Local Registraz AUG 12 2003 - Date N,ae.+ww..+a, COMYOMNEALTH pp PENHSYWANM DEPAgTMENT OP HEALTH • VITAL RECOppe ~ CEpTIFICATE OF DEATH ~++*rr~~~ (Coroner) xunc ~ ,. Gary + D Henrq + Male "~"~" .,,.. 206-32-4365 . aocorayaN~b,aa4,,ey , August 11 2003 61 v Abr4Cgtwl fwarlar~Cr,~p r•-w reeyryey , , .. Apr.18,1947 ' Porta9erPA pr fb ,r^ pq,y,ryr^ ~^ ~ ^ nns.w y"t P~NM1^ ~~ Cumberland North Middleton r rur, rnrre 60 Center Street w s.eb•aM ^ M r•~.\r .Mb IIk~, White ' r C~ ~Ofl Ccxletruction CO. w L~ w ^ N,r, -rrW amore a Vwnbbrr~ ~.wo err 60 Center St. ~db.avooal +e ~ 2 n•r .I DiVOrced Carlisle, PA 17013 ,n 1eM0"'~ rr. PA ~ ,~•.^w,er•e.eereb 1~. ..u~. __ ,~. Cumberland aWY.__... • Mb. } ~. M6 e...r.... •RNQI•r+'6 W11R(fyp,Nlkp Brian Nervy R(]th Oay.r.. to ~eW a...m^ w^rr,~.,w..^ D ' rraCe, NevVille, PA 17241 °'"r°" ° ,s~rr.+ D Ang.~.5. 2003 i `nand Vell Mem orial Carlisle, PA'17013 ~Nc r•rr+rrw.aarn °~r'"~ rr.were.enwar.r,be,rr.a ae,rrrarw '^• iBl PA 1701 ` ..rn.rw..r..a.w ~ prX. o•x wn .ef. a ee.eb N.r.ari~srrw+.renrr.a+ra ~ o•.arwwTerrAn 8t 11, 2003 u~ryr•rrrwr~rr. MCranrriars'rq'•M•mr raeaa r mob w^ . :.. J[ . r Mtrw. sarw ~Ia+~ jb4r rp ,wb,•wwb0'"~ ,aiw b b~M tr triripberly-- 1 g 01a1OjpRABA a~ Remote MI ~•~•~t +M :b ~ ~ a,ero ~ - +.+o~+r.gwr la1 " p,y tialo~reav wr.~acwronm w ^ w w ^ w ^ rrere O ~ °'+brrwe. ^ w ^ w ^ YR ~ ei D aewnr Ml~rnNw ^ wlrq re.grrlyj ~r~+•~•rwM,brp}rpr ea. y~ ~~~gy ~µ ~ p ~P1r~ DMYwIMw,•n•r,ep.r•N~ Mµlrsb ~~~VMeer~rN~•satlMrtlwnpbe 4nx6 llfl rrM.lwwrwrr~bbe ....................................... . ^ •' . . ............ •~ ~~bMR r.NwrMrMl~rr.WMIW1sN~~ba~Mrtlrw) •~•Irr~rrrrwb, " Corone~. pqE ,~ . .......................... ^ .. aurrarcata,ee „No .e"r.°b..~:'.a~i.s.',!°'°'""'r'o'°°w!^,~w~+r4e,.a•r~rwre.u,,.,,au.,,,,ewr,rua,rwa. rnn°'r^`" u ............ ' e r " ' Au at 12 2003 Mro Michael L. Norris Coroner m'" ........................................................ .. . . 6375 Baeehore Road, Su to fl ' M sf. a Ibr.~ ~' A . echanicabur , Pa. 170 + ~ M . ~~ ~...I ~ . ~ ,v: --~, ,., t` ..~.. 5 COMMONWEALTH OF PENNSYLVANIA GOVERNOR'S OFFICE OF GENERAL COUNSEL Apri16, 2010 Glenda Farner Strasbaugh Clerk of Orphans' Court and Register of Wills Court of Common Pleas of Cumberland County Orphans' Court Division Cumberland County Courthouse 1 Courthouse Square Room 102 Carlisle, PA 17013 Re: Estate of Gary D. Henry, deceased Court of Common Pleas of Cumberland County Orphans' Court Division No. 21 03-0727 Citation for Failure to File an Inheritance Tax Return Dear Ms. Farner Strasbaugh: r '~' ;' - - .~ ~ ~"_i ~ f? `` --' . Y ~ ti. J-: ~ ~7 rr, M ~~ ~. ~~ ~ to ~''~j ~'' ~ ri, Enclosed for filing please find an original and one copy of the Commonwealth of Pennsylvania, Department of Revenue's Praecipe to Discontinue the Citation issued in the above-captioned Estate for failure to file an inheritance tax return. Please file the original and time-stamp the copy and return it to me in the enclosed, self-addressed, stamped envelope. As the Citation is discontinued, please remove the April 8, 2010 hearing from the Court's docket. Please contact me if you have any questions. Thank you for your assistance. Sincerely, ~.. ,.:.- Lora A. Ku ick Senior Counsel Enclosures cc: Anastasia L. Dibartolomeo LAK:dmm #33166 OFFICE OF CHIEF COUNSEL ~ PO BOX 281061 ~ HARRISBURG, PA 1128-1061 ~ pennsylvania Ph: (717) 346-4644 ~ Fax: (717) 772-1459 ~ Ikulick@state.pa.us DEPARTMENT OF REVENUE IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: - ORPHANS' COURT DIVISION ESTATE OF GARY D. HENRY, DECEASED NO. 21 03-0727 PRAECIPE TO DISCONTINUE WITHOUT PREJUDICE To Glenda Farner Strasbaugh, Clerk of Orphans' Court and Register of Wills: The above-captioned action is a Citation for failure to file an inheritance tax return. Please mark this action discontinued upon payment of costs by the Estate as the Co- Administrators of the Estate filed the inheritance tax return. ~Q ~ a '~ sue. ~' ~ ~ DATE: April 6, 2010 g~ Lora Attorney for Petitioner PA Department of Revenue Office of Chief Counsel P.O. Box 281061 Harrisburg, PA 17128-1061 Attorney I.D. No. 69436 W .r. ,~ r ~_ ~,.,, 7'! ~~~ ,~ ~. _, ~~ v:r3 ~~ ~~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: . ORPHANS' COURT DIVISION ESTATE OF GARY D. HENRY, DECEASED NO. 21 03-0727 ORDER OF COURT AND NOW, this C~~ day of ' 2010, upon consideration of a Praecipe to Discontinue the within action, the Motion is granted, the Rule is dismissed and the Citation is discharged upon payment of costs by the Estate. BY TH URT: Judge ~.s 0 fir, ~ 1 : ~,") t~~. ~ N ~ -i'1 ~~ ~ ~f i ~ _ N ~~ W "7 ~ ~ , ~ Y" ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: GARY_ HENRY CUMBERLAND COUNTY PENNSYLVANIA NO. 03-0727 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 04/08/10 JUDGE'S INITIALS: TIME STAMP DATE: 04/08/10 IN ~~ ORDER OF COURT SERVICE TO: BRIAN HENRY CHRIS HENRY LORA KULICK PA DEPT OF REV METHOD OF MAILING: ENVELOPES PROVIDED BY• ® USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 04/08/10 ® PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT SERVICE TO: METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ENVELOPES PROVIDED BY• ^ PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT eputy Clerk of Orph s' Court ~rY i. 9 ~~ ! ~'` x Y~ ~Y AMT ~ ~Y },~. ~~ ~~ ' f[11~~rY . t;Rt' '~.1T j~y~ f ~~ ~, ~~~ ~a~ ~~ ~; ~~~ 4 x= ~~ 1 ZQiO aPP 26 r~ 3~ 19 M _ RYA ~~ !`~t_ ~ 1 i \ .~~ s ....,: oRP~,~, ~ , . f~~:.~.~~ C~ w T M N ~ ~~ C ~~` ~ ~ ~ ~, .. ...~ ~ ~ ~ ..... .r.. A wrpl~ +~ v ~ ~ c ` V V V ~ ~yl ~~1 !~ ~~ 1'~~ .r.., ~~o REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HENRY CHRIS D 79 HORSEKILRLGR A A1D257 SHIPPENSBU , PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 206-32-4365 2103-0727 HENRY GARY D 04/ 26/ 2010 04/ 24/ 2010 CUMBERLAND 08/11/2003 TOTAL AMOUNT PAID: REMARKS: CHECK# 702 SEAL INITIALS: JN RECEIVED BY: NO. CD 012659 AMOUNT $883.59 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 BRIAN K HENRY 46 MT VIEW TER NEWVILLE tNOTICE OF INHERITANCE TAX APP~A~3,.S~MENT,-~;,- I~LL.Q~NCE OR DISALLOWANCE O~F b~DU~~I~O~S'4AY1'D ASSESSMENT OF TAX .r ~._ ~ _ } lip ~ ~.`1 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: HENRY GARY DFILE N0.:21 03-0727 ACN: 101 DATE: 07-05-2010 TAX RETURN WAS: t ) ACCEPTED AS FILED ( X) CHANGED $EE ATTACHED NOTICE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest tSchedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers tSchedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses tSchedule H) 10. Debts/Mortgage Liabilities/Liens tSchedule I) Pennsylvania ~ DEPARTMENT OF REVENUE `• REV-1547 EX AFP C12-09) J NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. t8) 29,943.19 t9) 8 , 337.50 clo) 200.18 11. Total Deductions tll) 8,537.68 12. Net Value of Tax Return t 12) 21 , 405.51 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) t13) .0 0 14. Net Value of Estate Subject to Tax (14) 21,405.51 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date . ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate t15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate t16) 21 .405.51 X 045 = 963.25 17. Amount of Line 14 at Sibling rate t17) _0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 = .0 0 19. Principal Tax Due t19)= 963.25 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 04-24-2010 CD012659 .00 883.59 INTEREST IS CHARGED THROUGH 07-20-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. tl) .00 t2) .00 t3) .00 t4) .00 t5) 7 , 968.66 c6) .00 t7) 21 , 974.53 ~~I~ J~~~. ~ 6 ~~~ ~~; ~~ DATE 07-05-2010 ESTATE OF HENRY GARY D DATE OF DEATH 08-11-2003 ~L~FK (j- FILE NUMBER 21 03-0727 '~ '~`~ ~^'~'1,T COUNTY CUMBERLAND ~li.~~yr'~ ~-~-.' ~'_. r ~..~f , ~r~, ACN 101 APPEAL DATE: 09-03-2010 P A 17 2 41 ( See reverse side under Objections ) Amount Remitted l MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TOTAL TAX PAYMENT 883.59 BALANCE OF TAX DUE 79.66 INTEREST AND PEN. 346.16 TOTAL DUE 425.82 IF TOTAL DUE IS REFLECTED AS A "CREDIT" tCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.,1 REV-1470 EX (01-10) T. ~ ~~ :,.R enns lvan~a INHERITANCE TAX p y DEPARTMENT OF REVENUE EXPLANATION ........... . BUREAU OF INDIVIDUAL TAXES OF CHANGES PO Box 280601 17 1 DECEDENT'S NAME FILE NUMBER Henry, Gary 2103-0727 REVIEWED BY ACN Justin R. Gilmore 101 ITEM SCHEDULE NO_ EXPLANATION OF CHANGES G 2 The IRA is fully taxable as the decedent is the primary owner and the transferee is a beneficiary not a joint owner. Row Page 1 - _ _ _ _ .- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone : (717 ) 2 4 0- 6 3 4 5 r „nrn~~-,~~ rlr~4~`l~ l~!` ~"l{~ 210 JUL 2~ AM $~ 13 Date: 7/27/2010 CLERK OF pRpKAN~S COUR1 HENRY BRIAN K 46 MT VIEW TERRACE NEWVILLE, PA 17241 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~GGt~it.~,~Q~~z Glenda Farner Strasbaug Clerk of the Orphans' Court cc: File Counsel ,: _ _ _ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 fl~.Laiti~Ci: Li ii;a,.. J ~o~a ~u~ Ze a~ s~ ~ ~ Date: 7/27/2010 HENRY CHRIS D c~~ ~~ oR~s couR~ 79 HORSEKILLER ROAD SHIPPENSBURG, PA 17257 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET N0. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, 1.~~2r~t~J~~k'.c~6 «,~.~, , Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 _ ~ ,~#4µtf. 5 ~!:.- t,~}t'1 Za10 JU! c8 AM $~ 14 Date: 7/27/2010 RUPP STACEY L 61 MOUNTAIN STREET MT HOLLY SPRINGS, PA 17065 RE: Estate of HENRY GARY D File Number: 2003-00727 Dear Sir/Madam: CLARK OF ORPHAN'S, COURT ~MgFq~ ,n,~rn CO., PA This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the belos,N listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULE, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/11/2010 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, l~G~r~j Glenda Farner Strasbaug Clerk of the Orphans' Court cc: File Counsel itEC1STER t; r ~^i i' LS Gr 1Vallle of D2Cede.li: ~h CGL+vTY, PL'~t'~;SYL~V~,~i?, ~ j Date o`D~ata:_ ~ $~ ~/~ ~ D 0 3 File Nu.: ~o~T-• r~ ~ ~ 3~~p7 ~ 7 n~i' •1F tv Dn ('~ /'' ~ l~ f. 7'1 T r-yn ~.-t t:`°. .1 ~ a. ~ i~i.i3i ~ a c. v.~.. •ulw v. s_, .. f-~1t:41a~1;tr t;; ith r~cYa` t~ ~.11??~~!?,intl C!f il~c" 2Li~]?ia?tl'3t10C Or Y" a the above-captioned estate: 'i 1. State whether administration of file estate is complete :.................... ~ 'es ~ No 2. If the answeris V'o, state when the personal representative ~ . reasonably believes that the administration will be con~plet~: 3. If the ails-Ner to 1'v'o.. l is YES, state tie follo«,•in~: a. Did the personal representative file a fnal~account with the Courl? ....... des ~ No b. The separate Orphans' Court No. (if any) for the person~:l ' representative's account is: c. Did the personal representative state an account .. infolnially to the parties in interest? .:............................. ~ (~1'r,=s ONo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts', nlay be filed with the Cleric of the Orphans' Court a!ld may be attached to this re. t. ~ ', Onre / ~ '~ ~~~ ~ D ..:~nar.:re of Peron Fifirg (iris Fa• ~ Cy5 ~ N 1 Capaciy: ersonal Representative Coup~sel U_~ ,, U - y ~ '+rz: Via- ~ . ~'~ 2. .~ i- '_ ~ ~~Q P:nr.:e of Pzrsan FilirgtF.it ruru~ t. t..t ~-i.l ~ [~ " ~ 1. ~},iCl l~S ~..~ t _ L~ C~ V /` /~ ~-u ~ rr O ~ ~ ~ o S~B' "_ Ir~~~ 7''.~j 7 c c`'~ . 1 relzp;~onz ~P~'n~?_~~.C ~~~~;~ G ~~,~~ ~ n ZalO SEP 27 QM I1 ~ 2 CLERK nP OR~iAN'S COURT CUh~BERLANG C~.. PA, In Re: Estate of HENRY GARY D ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-0(1727 NOTICE OF FAILURE TO FILE STATUS REPORT Fersonal Representative: HENRY BRIAN K Counsel for Personal Representative: Date of Decedent's Death: 8/11/2003 The Orphans' Court record indicates that neither the above named personal representative nor ~tlae above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and thak tine requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given that yo~l have ten (10) days to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 rthe Court will be notified of such delinquency and the undersigned will request that a Court conduct a hearing t4 determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. L~~arc/ ~y~f'~~ Date: 9/27/2010 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File II~US~ ~.~ ~tJl ~ 3~,.4:v 20tO SEP 21 AM I t ~ 26 CtFRK OF ORP4~N'S COURT In Re: Estate of~N}R~~?L~Q!~~ ~[~„ pA HENRY GARY D ORPHANS' COURT DIVISION COURT OF COMMON PLEA5 OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00727 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: HENRY CHRIS D Counsel for Personal Representative: Date of Decedent's Death: 8/11/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given that you have ten (10) days to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will request that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. t~w~ Date: 9/27/2010 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File Gov 1 ~ ~a~~~ IN RE: ESTATE OF ~~~,~~~~~:. ~; ,o~;~~_~ ~ ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF HENRY GARY D 2Qi0 NOY 16 PM 3= OZ ~ CUMBERLAND COUNTY.. .PENNSYLVANIA CLERK OF ' ' QT'S CQI~RT NO. 2003-00727 CUMBERLAND CO.. PP. NOTICE OF FAULURE TO FILE STATUS REPORT AND REQUEST TO CO~iDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' C(~iJIPIT RULE Personal Representative: HENRY CHRIS D Counsel for Personal Representative: Date of Decedent's Death: 8/11/2003 Date of Delinquency Notice: 9/27/2010 The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accor~anjc~ with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk, of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orpharxs' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules ±was given on the above date and that the ten (10) day notice to file the Status Report has expired. Accordin~~y, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the under~i~ned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 11/15/2010 Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for 12/17/2010 9:30 A.M. ~a~rilOfGJ~, Glenda Farner Strasbaugh Clerk of Orphans' Court in Courtroom No. 4. If the Status Report is filed prior to the hearing date, the hearing wild automatically be cancelled. Kevin ess, P.J. --~ ~ i IN RE: ESTATE OF HENRY GARY D 4,. ~r F~~tC~1a 1 ~;, ~, 2810 NQY 16 PM 3' QZ ~S OURS NQV 15 ~~1(~ ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00727 NOTICE OF FAULURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' C011JRT RULE Personal Representative: HENRY BRIAN K Counsel for Personal Representative: Date of Decedent's Death: 8/11/2003 Date of Delinquency Notice: 9/27/2010 The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division,'~Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphams' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules' was given on the above date and that the ten (10) day notice to file the Status Report has. expired. Accordingay, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon thie delinquent personal representative or counsel for the delinquent personal representative. Date: 11/15/2010 Distribution: Personal Representative Counsel for Personal Representative Estate File Glenda Farner Strasbaugh Clerk of Orphans' Court A hearing is scheduled for 12/17/10 9:30 A.M. in Courtroom No. 4. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. Kevin A. ss, P.J. }, ~, ~, Yt~~:`~l`i~ 1J1.~ 4 4 ~~ ~ OOH' ~ ~ d j ;.~ '.. .,. ~,• ~ .~. 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