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HomeMy WebLinkAbout02-13-091505605.1.058 REV-1500 EX (OS-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes ~ .~, County Code Year File Number Po aox 2aosol ~~ INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 ~~ RESIDENT DECEDENT 21 08 1 174 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 575-18-9704 11/18/2008 11/20/1913 Decedent's Last Name Suffix Decedent's First Name MI Henry Dorothy (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW • 1, Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS _ 2. Supplemental Return _ 3. Remainder Return (date of death 4. Limited Estate 4a. Future Interest Compromise (date of pnorto 12-13-82} 5 death after 12-12-82) . Federal Estate Tax Return Required • 6. Decedent Died Testate (Attach Copy of Will) 7. Decedent Maintained a Livin Trust g (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10. Spousal Poverty Credit date of death ( 11 between 12-31-91 and 1-1-95) . Election to tax under Sec. 9113(A) (Attach Sch O) . CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIA Name L TAX INFORMATION SHOULD BE DIRECTED TO: Andrew C. Sheely, Esquire Daytime Telephone Number 717-697-7050 Firm Name (If Applicable) Andrew C. Sheely, Attorney at Law r.a It~c'~°r~~wlt-t-s u~t~lvty _, ;~__ First line of address ~ w f'r'1 ti 127 South Market Street ,, ~~~->`J ~ ~ - Second line of address w ~ ._'~~ i ' "• . 7 P.O. Box 95 _ , .. ` ~ t-~ T~ ,.~ ~ .''y J~~_ _. _-. City or Post Office . l,0 -:,.t =o =-t .. r _ State ZIP Code ~A1t= r'ILErt ~ Mechanicsburg A,,,~~ on ~' Correspondent's e-mail address: andrewc.sheely@verizon.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct a d complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE F P RSON RESPON I R FILING RETURN Ja _ _ _ enry, Executor, 601 S h Market St.,Mechanicsburg, PA 17055 SIGNAT E OF PREPAg~ ~E THA EPRESENTATIVE ~~~.~ ~- ( n ~ c __ __ Andrew C. Sheely, Esquire, 1 outh Market St.,Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY ~~l / n HATE /~,~~y 1 505605.1058 Side 1 15056051058 1505605205~~ REV-1500 EX Decedent's Social Security Number 575-18-9704 Decedent's Name:. H0.11rY ~ DOrO~rly RECAPITULATION ............................................ 1. Real estate (Schedule A). 1 2. Stocks and Bonds Schedule B 2' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) ,Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 1, 367.48 30,593.74 203,990.79 235,952.01 9,038.35 267.33 9,305.68 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12 '' 226,646.33 . . 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which . an election to tax has not been made (Schedule J) ...................... .. 13. 14 226,646.33 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unc~~~ sec. 9116 15. (a)(1.2) X .0 16. Amount of Line 14 ~~~able 226 646.33 16 10,199.08 , at lineal rate X .045 17. Amount of Line 14 taxable 17 at sibling rate X .12 . 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 19. TAX DUE ...................................................... ...19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505605205~~ Side 2 150560S205y RFV 1 X00 EX Page 3 Decedent's Complete Address: DECFIIFNT'.~ N6r,1F Dorothy Henry STREET ADDRESS 100 Mt. Allen Drive CTV Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) CreditslPayments A. Spousal Poverty Credit B Prior Payrnents C. Discount 3. Interesti'Penalty if applicable D Interest E Penalty Total Credits (A + g + C) (2) 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT tal Interest/Penalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :...................................................................................... Yes .... ^ No 0 b. retain the right to designate who shall use the property transferred or its income :......................................... ... ^ [f c. retain a reversionary interest; or ............................................................... d. receive the promise for life of either payments, benefits or care? ............................................... .................. ^ ^X .. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ... without receiving adequate consideration? .................... . ..... .. ........................................................................ 0 .... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........... ... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ... contains a beneficiary designation? ..................................................................................................................... ... ^ n 10,199.08 10,199.08 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does n_ of exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. STATE PA ZIP 17055 10,199.08 9,689.15 509.93 File Number 21 08 ' 1174 DECEDENT'S SOCIAL SECURITY NUMBER _. 57.5.-18-97Q4 NE':'v-7503 EXt is-sal CpMMONWEAL'fH pF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEN"t DECEDENT SCHEDULE B STOCKS & BANDS FST4TF f)F Dorothy Henry, aka Dorothy L. Henry ____ Ali property )ointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTIQN ~ MetLife Coml~non Stock - 68 shares valued at $2t?.111share at date of death TOTAL (Also enter on line 2 Recapitulation)' $ (li more space is needed, insert additional sheets of the same size) FILE NUtUIBER 21-08-1174 VALUE AT DATE Of DEATH 1, 367.48 1, 367.48 Investor Relations ~~~~~~.~~~~ ~~,.f~~ ~~~~~~ Company Overview Symbol Executive Officers MET (Common Stack) Board of Select Date Directors November +~ 18 ~ 2008 ~ rook up PYlCe Stock information Results Stock Quote sto~:k et,a,e Date Requested 11/18/08 Histuricai Price Lookup Closing Price $20.72 Investrne"t Cak~.dator Volume 44,280,600 Financial Split Adjustment Factor 1:1 int-"orrnation Open $22.68 News & Events Day's High $22.78 ~~,,nn,, " r~ti ~ ~~ ~ Conferences & r„ ~ Day's Low $17.44 ~~-'d` `~ Presentations Analyst Coverage Copyright ©2008 MarketLVatch, Inc. All rights reserved. Please see our Terms of Use . Designed and powered by Dow~o~es CI"ent SoJu ttons Shareholder Services _ Intraday data provided by Fnteracgv_e Data Reel Tlme services and subject to the Terms of Use. Intraday data Is at least 20-mlautes delayed All times ar Ei information . e , Historical and currant end-of-day data provided by IE,teract ve Data f~ricinc~and Reference Data. E-mail Alerts Information Requests Contact Information Copyright 2003-OS hletropolitan Life Insurance Company NY, fVY -All Rights Reserved PEANUTS Copyright UniCec Feature Sy„dicate, Inc. print scra~en Privacy Policy Legal Notices http://investor,inetlife cony/pl~oenix.zht~~~i?c=12117!&p=irol-stocklookup&t=HistQuote 12/5/2008 R~~_V-150N EX+ (6-9~8) COMMONWEALTH OF PEN!VSYLVANIA INh1ERITANCE TAX RE TURN RESIDENT DECEDI NT S~NEDULE F JOINTLY OWNED PROPERTY ESTATE OF Dorothy Henry, aka Dorothy L. Henry If an asset was made joint within one year of the decedent's date of death, If must be rel SURVIVING JOINT TENP,NT(S) NAME ADDRESS A James E. Henry 601 S. Market Street, Mechanicsburg, PA 17055 S Robin L. Hatcher ' 6116 Locust Street, Harrisburg, PA 17112 C JOINTLY-OWNED PROPERTY Daughter R E:P! NL'IdBER LETTcR DATE FCFl J06vT MADE TENANT JOINT DESCRIPTION OF PROPEPTY INC:.UpE NAME OF FINANCIAL INSTITUTION AND DANK ACCOUNT NUMBER OR SIMILAR ~•° OF DATE pF DEATH ~ A. B 1994 - IDENTIFYING NUMBER. ATTACH DEED FOR ,IOINTLY-HELD REAL ESTATE. Allegheny Energy common stock -718 4063 sh DATE OF DEATH VALUE p=ASSET DECD'S INTEREST VALUE OF DECEDENT'S INTEREST . ares valued at $28.941share al date of death 20,790.68 33.3 6,930.23 2. A,B 1994 Alcatel-Lucent common stock - 98 shares valued at $2.351share at date of death 230.30 33.3 76,77 3. A,B 1994 AT&T common stock - 7,155.850357 shares valued at $26 39ishare at . da#e of death 188,842.89 33.3 62,947.63 4. A,B 1994 Comcast common stock - 322 shares valued at $15.041 share at date of death 4,842.88 33.3 1,614.29 5. A,B 1994 Creyfus Premier State Municipal Bond Fund - 2,765.329 shares valued at $14.69/share ai date of death 40,622.68 33.3 13.540.89 6. A, B 1994 Fairpoint Communications common stock - 333852 shares valued at $~?.38/share at date of death 79,46 33.3 26.49 7• A, B 1994 Idearc, Inc. common stock - 79 shares valued at $.09/share at date of death 7.11 33.3 2.37 8. A, B 1994 LSI Corporation common stock - 28 shares valued at $2 95/share at date o+ death 82.60 33.3 27.53 9. A, B "994 N~~R common stock - 49.42 shares valued at $?5 541share at d t . a e of death 767.99 33.3 256.00 10. A,B 1994 PAL Resources common stock - 9,510.323 shares valued at $32 26/sha . re at date of death 306,803.02 33.3 102,267.67 11. A,B 1994 Teredata Corp common stock - 49.42 shares valued at $12 24/share at . date of death 604.90 33.3 201 63 12. A,B ?994 Verizon Communications common stock - 1,684,61397 shares valued at - $28.67lshare at date of death 48,297 88 33.3 16,099.29 The above-referenced stocks were originally titled jointly in December of 1994, subsequent splits and issuances of new stock were created from the stc;cks titled jointly in 1994, All stocks were created jointly in excess of one year prior to November 18, 2008. ~u more space is needed, insert additional sheets of the same size) TOTAL (Also enter on tine 6, Recapitulation) ~ $ 203 , 990.79 FILE NUMBER 21-08-1174 on Schedule G. RELATIONSHIP TO DECEDENT Son iFV-1'511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT cAIHIC Vh SCHEDULE H FUNERAL EXPEN5ES & ADMINISTRATIVE COSTS Dorothy Henry. aka Dorothy L Henry FILE NUMBER 21-08-1174 -- Debts of decedent must be reported on Schedule I, ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION t Zimmerman Auer Funeral Home, Inc. B. ADMINISTRATIVE COSTS: t Persona; Representative's Commissions Name of Persona! Representative(s) ~at11BS E. Henry Social Security Number(s)1EIN Number of Personal Representatives} street address 001 South Market Street city Mechanicsburg state PA zip 17055 II Year(sy Commission Paid: 2 Attorney Fees 3. Family Exemption: Qf decedent's address is not the same as claimant's, attach explanation) Claimant Street address City State Zip Relaronship of Claimant to Decedent 4 Probate Fees 5• Accountant's Fees 6. Tax Return Preparer's Fees ~. Filing Fees $ Reserves to conclude administration of the Estate 9. Misc. postage ---- TOTAL (Also enter on line 9, Recapitulation} $ (if more space is needed, insert additional sheets of the same size) AMOUNT :~ ~ .OZ':~ .f , 0 C)0 136. U0 15 OCl 500.00 `I1 1~~ 9,038 3> immerman uer FUNERAL HOME, INC. 4100 Jonestown Road, Harrisburg, PA 17109 717-545-4001 may. _ - - _ _ _=_~ ;i~ i~' - ;_ , Robert L. Hendricks -Supervisor 28089 ANRH Mr. James Edgar Henry 601 S. Market Street Mechanicsburg, PA 17055 Nov 19, 2008 Dorothy L. Henry - Deceased SPECIAL CHARGES Direct Cremation Forwarding Remains Receiving Remains Immediate Burial Nationwide Guarantee Program Worldwide Travel Protection TOTAL SPECIAL CHARGES S0 00 PROFESSIONAL SERVICES X Services of Funeral Director & Staff 53,595.00 Embalming Dressing/Cosmetizing/Casketing Facilities & Staff for Viewing ($200/hour) X Facilities & Staff for Funeral Service $550.00 Facilities & Staff for Memorial Service Staff & Equipment for Viewing {$200/hour) Staff & Equipment for Funeral Service Staff & Equipment for Memorial Service Private Family Viewing Witnessing the Cremation Packayiny,'Forwarding of Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains TOTAL PROFESSIONAL SERVICES $2,145.00 AUTOMOTIVE EQUIPMENT X Removal Vehicle $250.00 X Casket Coach $25@.00 Flower Car X Lead Car/Clergy Car $175.00 Service Vehicle Family Car TOTAL AUTOMOTIVE EQUIPMENT $675.00 MERCHANDISE Register Book X Memorial Cards 100 @ $45,00 6o Tax Thank You Cards Remembrance Package X Montgomery Ash Full Couch Casket Cardboard Container Alternative Container Outer Burial Container Veterans Flag Case Grave/Memorial Marker $2.70 $47.70 $3,495.00 TOTAL MERCHANDISE CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Vault Service Charge Newspaper Notice X Patriot Newspaper Notice :: X Clergy X Church/Organist/Soloist Flowers Crematory Charge County Coroner Fee X 25 Certified Copies of Death Certificate TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges $0.00 Professional Services $2,145.00 Automotive Equipment $675.00 Merchandise $3,542.70 Cash Advanced Items $662.47 SUB TOTAL $7,025.17 CREDITS $0.00 AMOUNT PREPAID $0.00 TOTAL $7,025.17 AMC~uNT PAID $0.00 BALANCE DUE $7,025.17 $312.47 $100.00 $100.00 $150.00 ;,.,, X41 . lY1 $562.47 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 11/24/2008 Cumberland County - Register Of Wills Receipt Time: 14:12:14 One Courthouse Square Receipt No.: 1054851 Carlisle, PA 17613 HENRY DOROTHY Estate File No.: 2008-01174 Paid By Remarks: JAMES E HENRY CJ ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 90.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE JCP FEE 15.00 16.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN AUTOMATION FEE 10.00 5.00 BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN Check## 7688 $136 00 Total Received......... $ . 136.00 R='~d-?512 Ex+li?-U3 S" CON~MONWEALTH OF ?ENNSYLVANIA INHERITANCE TAX RI-TURN RESIDENT DECEDENT SCNEDYLE ! DEBTS Of DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE C1F Dorothy Henry, aka Dorothy L. Henry Fu F fltu~naFR 21-08-1174 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM _ _ NJMBER VAI_UEAT DATE -- - DESCRIPTION OF DEATH Alert Pharmacy -final bill -- $?4fJ.00 2 Mobile X-Ray Service -final bill 1::~ ,>4 3. Misc. check routing fee -Members 1st 11.94:0 TOTAL (Also enter on line 10 Recapitulation) $ ~ <?(i 7 3: {If more space Is needed, Insert addlhonal sheets of the same s¢e} _- --- RE's'-7!1'3 EX+ 19.OQ1 ~ .. COMMONWEALTH 0~ PENN;YLVANIA NHERITANCE TAX RET.IRN RESIDENT DEGEDEP<T 5C~lEDULE J BENEFICIARIES ESTATE OF Dorothy Henry, aka Dorothy L. Henry NUMBER NAME APJD ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS linclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. Girton E. Henry, 5215 Crestwood Dr., Harrisburg, PA 17109 2. James E. Henry, fi01 South Market St., Mechanicsburg, PA 17055 3. Robin L. Hatcher, 6116 Locust Street, Harrisburg, PA 17112 4. Bonnie L. Jones, 5111 W. Princeton Place, Spokane, WA 99205 II FILE NUMBER 21-08-1147 RELATIONSHIP TO DECEDENT ~ AMOUNT OR SHARE Do Not Llst Trustee(s) OF ESTATE Son Son Daughter Daughter 25 % of Rest, Residue 25% of Rest, Residue 25% Of Rest, Residue 25°1° of Rest, Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REIV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. GHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II --ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET {If more space is needed, insert additional sheets of the same size} ~ LAST WILL AND TESTAMENT OF DOROTHY HENRY I, DOROTHY HENRY, a domiciliary o:E the State of Penney].vania, being oi: sound and disposing mind and memory, do rexeby make, publish and declare this instrument to be my LAST WILL ANA TESTAMENT. I heKeby revoke auy and all wills and cgdieila by me heretofore made. z IDENTIk'ICATIONS AND DEk'INl;TIONS x I am married to GIRTON N.. HENRX ("my Husband"), We have three children, GIRTON l3. HENRX, JAMES E, HRNRY, and ROBIN L, l,EON~IARA, References in this Will to "rny Children" include these three children a.nd any ether lawful. children born to or adq~ted by me. The following definitions obtain l.n any use of the teams in tktis Will: 1 , "Descendants" means the iin~mediate and xemote lawful , lineal descendants of the person xe~exxed to, and it means those descendants i,n bel,ng at the time they must be ascertained in order to give effect to the reference to them, whether they axe boxn before or aftex my death ar of any other person. The persons who take under this Will. as Descendants shall take by right of representation, iz~ accordexa,ce with khe rule of per stirpes distributl,pn and not in accordance with the xule of pear capita distribution, Persons legally adopted when under the age of fouxteen years shall, not be differentiated from blood descendants for any purpose. 2 "Survive me" is to be construed to mea>l~ that the pereoo, referred to must survive me by thirty days, If the person xeferr.ed to dies within thirty days of. my death, the reference Co him shall be construed as if he had failed to survive rne, (Page ~. of 4 Pages) ' %, ~1 C ~d {.,.4~ II YAXMENT aF DEBTS ANA TAXES I direct my executor to pay the following before any division or distribution under the following articles: 1, All of the expenses of my last illness, funeral. and of the administration of my estate, :. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes, yiy executor shall not require any beneficiary under this will to reimburse my estate for taxes paid on property passing under the terms of this will, TIT RESIDUARY ESTATE A, I define "my Residuary Estate" as all of tpy propeYky after the payment of debts and taxes under Article IZ above, including real and personal property, whenever acy,uired by me, property as to which effective dl.sposition is not otherw~,se made in this will, and property as to which I have an option to purchase or a reversionary interest, but exclucing property as to which I have na interest other than s power of appointment, B, T give my Residuary Estate to my Husband if he survives me, C, If my Husband does not survive me, I direct m exec t my Residuary Estate into equal shares and to distribute those sharesdaside follows: .~ 1, one share to each o£ my Children then living; 2. one share to the then living Descendants of each o£ my Children who is not then Hying, IV APPpINTNiENT flF EXECL'TgR I appoint my Husband, GIRTON H, HENRY, as Executor of this Will, If GIRTON H. HENRY is unable or unwilling to serve in this capacity, I appoint my son, JADIES E, HENRY, to serve instead, I request that my executor not be required to furnish bond or securities, (~a$e 2 of 4 k'ages) ~~.~~! C ~L% IN Y~'TTNESS WHER~EOa~F", I have at Carlisle Aarracks , Pennsylvania, this ~ z~day of l.~'-~'-+~ , 1979, aefi my hand and seal to this my LAST WILL ANll TESTAMENT cons iating of roux (4) ty~ewxitt~n pages, this included, the pxeceding pages h.sxeo~ beating my aigzxature, / f ~. :` ~~~ (SEAL) Signec], sealed, published and declared by the above named 'fiegtatrixa as her LtiST WILL ANA TESTAMENT, in the pxeaence of all o~ us at one time, anti at the 8a.me times we, at her xequsat and in, lzer pxeaenc~ a.nd in the pxeaez~ce o~ each oth.ex, have hex'eunto autaacribed oux' names as a.ttesti~~g witnesses, and we dq hexeby attest to the aouztd and disposing mind and mernoxy o~ said testatrix at the date hexeq~, and tq the ~e+x~armanee of- the aforesaid acts a£ e,~.ecutian a,t CaX'l~sle AAxxaclca, ~'enns;ya.yania, this ~/^~~r;day of ~:C,____, 1979. NAZI r 1 -r ~ ~, ~ ~~ ]., AADRESS ~. /~l (Page 3 of 4 1'agea) COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUriBERLAND ) ss: Before me, the undersigned authority, on this day personally appeared DOROTHY HENRX, Rsoa A. Ortiz , Steve DiDomenico and Dixie Lee Stoner , ngwn to me to be the testatr~.x and t e witnesses, respectively, whose names are subscribed to the annexed ox foregoing instrument in their respective capacities, and a11, of said persons being by 'me duly sworn the said DOROTHY HENRY, testatrix, declared to me and to the said witnesses, in my presence that said instrument is her LAST WILL ANA TESTA~'1,ENT, and that she had willingly made and executed it as her free act and deed for the purposes therein expressed; and the said witnesses, each on his oath, stated to me, in the presence and hearing of the said testatrix that the said testatrix had declared to them that said instrument is her LAST WILL AND TESTAMENT, and that she executed same as such and wanted each of them tq sign it as a witness; and upon their oaths each witness stated further that they did sign the same as witnesses in the presence o£ the said testatrix and at her request; that she was at that time eighteen years of age or over or being under such ag.e, was or had been lawfully married, or was then a member of the armed forces of the United States or of an auxiliary thereof qr of the Maritime Service and was of sound minds and that each. of said witnesses was then at least fourteen years of age. Subscribed and acknowledged before me by the said DOROTHX HENRX, testatrix, and subscribed and sworn to before me by the said Rosa A. Ortiz ~ Steve DiDomenico , and Dixie Lee Stoner witnesses, thzs ~7t day of Octo er lg~~, zGc~../ NOT RY PUBLIC ~~~-'"'-" My Commission Expires (Page 4 of 4 Yages) ~~+~ ~• G:~knter, Pfotnry Puf~fir Mor!fir ~7kfctleston Tarp., f.'irrat*:rl:~n~! (;aunty Nty G:rr..•.rni+:s#~rr CM~irss. Feb. S, 13$3 h9en~;:'~r, P;r~ir~iyi~t,tgi:t dS:OCiGan of 'i~letaries WITNESS -'-