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HomeMy WebLinkAbout11-03-11 ,~,,,~ 15 D 5 610101 REV-1500 ~t01-1°> PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes OFOAATMFMi 11F A[yFMY[ PO BOX z8o6o1. INHERITANCE TAX RETURN .County Code Year File Number Harrisbur , PA i 128-0601 RESIDENT DECEDENT ~ ~ ! I p ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDWYY Date of Birth MMDDYYYY 193-12-9310 .06/25/2011 06/13/1927 Decedent's Last Name Suffix _ _ _ HENRY Decedent's First Name MI .CHARLES A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name HENRY MI SANDRA S Spouse's Social Security Number -__ . ....................... . .. _ ................._........... ............... .........._... ..............: HIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS C~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O 4a. Future Interest Compromise (date of Prior to 12-13-82) death after 12-12-82) O 5. Federal Estate Tax Return Required ~ Ci. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes O 9. litigation Proceeds Received O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 11 • Election to tax under Sec. 9113(A) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT ON S OULD BE DIRECTED T0: Name THOMAS E. FLOWER Daytime Telephone Number (717) 243-55~ ...,, ,_ REGISTER ~Q~TjtLg USE pN~.y ~ ~ '~ r;J't7 "'1 ` ~ First line of address -X.i T~ ~ ` ~ ~ ~_" _ ~,. 7.. ~~ ~ t~t t ~ '' I FLOWER LAW, LLC _ _ _ -+TJ - ry 7 ~' 7~ ~ r--; .._ Second line of address - -- - --~ ~ j ~ > ' -' -. ~) rt -... 10 W. HIGH ST `ice '~ : ~`-~' City or Post Office ..__ State ZIP Code DATE FILED y"'" ~ CARLISLE PA 17013 ............ orrespondent's a-mail address: TOm(U7FIOWer-Law.CDm Under penalties of perjury, I declare that I have examined this return, including acoom an in it is true, correc nd complete. n of prepan:r other than the P y g schedules and statements, and to the best of my knowledge and belief, P SIGNATURE ERSON RESPONSIB F Personal re resentative is based on all information of which re ` ING RETURN P parer has any knowledge. ADDRE S DATE Sandra S. Henry, Executrix, 5 93 Bridgeview Dr., Lemoyne, PA 17043-1380 f r Z /, GNA E OF P P R ER THAN REPRESENTATIVE ADDRESS DATE Flower Law, L.L.C., 10 W. High St., Carlisle, PA 17013 L© ~~ ~< PLEASE USE ORIGINAL FORM ONLY t_._ Side 1 1505610101 1505610101 J ~....,~ 1505610105 REV-1500 EX Decedent's Social Security Number ~ecedenrs Name: CHARLES A. HENRY R ' 193-12-9310 ECAPITULATION 1. Real Estate (Schedule A}......... ....... ........................ 2. Stocks and Bonds (Schedule B) ...... ..... 1. 0.00 °° 3. Closely Neld Corporation, Partnership or Sole-Proprietorship (Schedule C} 2. 3 224,966.53 4. Mortgages and Notes Receivable (Schedule D) ...... ..... , 0.00 . ................ 5. Cash, Bank Deposits and Miscellaneous Personal Pro e p rty (Schedule E) .... 4. 0.00 .__ _. ... 6. Jointly Owned Pro e p rty chedule F g q Re nested 7 G .. 5, . 0 00 ' "` °~ " °"' °° ' °--°- ... . Inter-Vivos Transfers & Miscellaneo s No n-P obaae Property (Schedule G) .... 6, 0.00 -- O Separate Billing Requested.... .. 7 8. Total Gross Assets (total Lines 1 through 7) ....... .. . 16,198 79 _.... . ..................... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) . 241,165.32: .... . .......... ... 9.: 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ... 10 11. Total Deductions (total Lines 9 and 10) ........ .......... . ............ : .... . ................ ... 11. 12. Net Value of Estate (Line 8 minus Line 11 - --` 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~~~~~~~ an election to tax has not be 12 ~~ 241,165.32 en made (Schedule J) ...... . ....... . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) 0.00 TAX rei ri~~ AT1/1~~ e..-.....__-. . ...... ... .. 14. 7AA AC! nn -- ~-- -~-~~ ~~~• - ~~e ~n~ t RUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 - (a)(1.2) x .0 0 191,165.32 16. Amount of Line 14 taxable 15. at lineal rate X .0._ 17. Amount of Line 14 taxable 0.00. 16. at sibling rate X .12 50,000.00 18. Amount of Line 14 taxable - - 17. at collateral rate X .15 ~ f1n I o. ..._._ 19. TAX DUE ...................... __ .. ..,. ......., ..,. ................................... 19. __ _._ 6,000.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O ~,.~, 1505610105 Side 2 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: CHARLES A. HENRY STREETADDRESS 539 BRIDGEVIEW DR. CITY LEMOYNE Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ B. Discount 3. Interest 4. If Line 2 is greater than Line t + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. F(le Number STATE ZIP PA 17043 {1) 6,000.00 Total Credits { A + g) (2) 0.00 (3) 0.00 (4) 0.00 (5) - 6, 000.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE B 1. Did decedent make a transfer and: LOCKS a. retain the use or income of the ro Yes No P Pedy transferred :................................................................................ ^ b. retain the right to designate who shall use the ro '"""""' ~ x P Perly transferred or its income : ............................................ ^ 0 c. retain a reversionary interest; or ......:........................... d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................:............................ ^ x 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which ^ contains a beneficia desi nation? .............................. .............. ry 9 .......... ............................................................... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETU RN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the suNivin 3 percent (72 P.S. §9116 (a) (1.1) (i)], g spouse is For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 rcent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets an filing a tax return are still applicable even if the surviving spouse is the only benefiaary. ~ d For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural anent an adoptive parent or a stepparent of the child is 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 4.5 ercent ex p 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblin s is 12 p cept as noted in Section 9102, as an individual who has at least one parent in common with the decedent, whether by b ood or adoption116(a)(1.3)J. A sibling is defined, under REV-1503 EX i- 16.98} ~` ~k.., COMMONWEAI:iH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS CHARLES A. HENRY ESTATE FILE NUMBER 21-11-0741 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM (UMBER DESCRIPTION ~~ 5,000 PHILA PA WTR REV BOND SERA @ 1.07872 2~ 10,000 PA ST HIGHER EDL FACS AUTH REV BOND SERA @ 1.12419 3. 10,000 PA ST GEN OBL BOND @ 1.13333 4. 25,000 HBG PA PKG AUTH REG GTR FEF BOND-SER J @ 93.734 5. 5,000 GREATER JOHNSTOWN PA SCH DIST REF BOND @114.9935 6. MORGAN STANLEY BANK NA SALT LAKE CITY UT CD PAYING 4.25% FACE VAL 5,000 7. 7,812.802 SH. PIMCO TOTAL RETURN FUND C @ 10.995 8. 5,484.430 SH. PIMCO UNCONSTRAINED FUND C @ 11.085 9. 15,000 DELAWARE VAL PA REGL FIN AUTH LOC GOVT REV BOND SER-B @1.05164 TOTAL (Also enter on line 2, Recapitulation) S (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 5, 393.60 11,241.90 11,333.30 23,433.50 5, 749.68 5, 343.28 85,901.76 60, 794.91 15,774.60 224,966.53 4507 North Front Street Suite 201 Harrisburg, PA 17110 tel 717 255 6666 Fax 717 255 6651 toll Free 800 676 0673 Date o f Death Evalu ti a ons MorganStanle SmithBarne Y _ Dvc Security Name Philadelphia PA Water & CUSIP/Symbol Deathf Closing Price Date Closing Sewer Rev Ser A 717893QB0 Price Date 9 dO p ~ Pennsylvania St Higher Edl Facs Auth Rev S 6/25/2011 107.877 20110624 107.867 20110627 b epo ~ er - A Pennsylvania St Genl 70917NQ56 6/25/2011 112.424 20110624 112 414 ~reop Oblig Harrisburg PA Pkg Auth 7091413H6 6/25/2011 113.338 20110624 . 20110627 Reg Gtd Ref-Ser J 414758GP1 113.328 20110627 ,roe 0 Greater Johnstown PA 6/25/2011 93.733 20110624 93 735 School Dist Ref 392023KG1 . 20110627 '' -,eoo Delaware Valley PA Regl 6/25/2011 114.997 20110624 114.99 20110627 Fin Auth Loc Govt Rev ~oDD Ser B Morgan Stanley Bank N.A 246579DT0 6/25/2011 105.164 20110624 105 164 Salt Lake City UT CD i Pimco Total R t 61747MTV3 6/25/2011 106.865 2 . 106.866 20110627 ;~12' $o e urn Pimco Unconstrained Bd P~CX 6/25/2011 11.01 20110624 20110624 2 20110627 ~ I `E~~ '~ 3O r4ND C 10.98 20110627 . PUBCX 6/25/2011 11.09 20110624 11 08 . 20110627 This report has been generated from information that Morgan Stanley Smith Barney LLC and its Financial Advisors and Investment Representatives (collectivel ~~ ~~ accurate. We do not, howeverY representuor)warrantethe accuracybor and completeness of the information contained in this report. You, the client, have provided us the data from which this report has been generated. The report has been calculated from software and formulas that were not developed by us. As such, all calculations, estimates and opinions included in this report constitute our best judgment as of this date and upon the information you have provided us and may be subject to change. It is your responsibility to do and check calculations to determine the accuracy of ythe informationlon, contained in this report. Neither we nor our affiliates will be responsible for the consequences of your reliance upon an calculation or other information contained herein or for an~Pinion, y omission. Morgan Stanlty Smirh Barney LLC. Member SIPC. REV-1737-6 EX + (6-06) pennsylvania DF.PARTN~ N1 qF REVENUE [NHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & Use Schedule G, Part 2, ONLY for MISC. NON-PROBATE PROPERTY proportionate method of tax computation. is IArE OF CHARLES A. HENRY FILE NUMBER 21-11-0741 Part 1 must include all transfers of real estate and tangible personal property located in Pennsylvania. Complete Part 2 ONLY when the proportionate method of tax computation is elected. Include in the description of property the date the transfer was made and the name and relationship of the transferee. This schedule must be completed and filed if the answer to questions 1 through 4 on the reverse side of the REV 1737 cover sheet is yes. - ~ .~. ~ ~ ~ DESCRIPTION OF PROPERTY + ~ ~ ~ ` ~ ~ ITEM Include the name of the transferee, the relationship to Decedent and the date of transfer. DATE OF DEATH % OF DECD'S EXCLUSION NUMBER Attach a Dopy of the deed For real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE 1. PART 1 TOTAL ~ $ 0.00 - .- DESCRIPTION OF PROPERTY ITEM Indude the name of the transferee, tits relationship to Decedent and the date of transfer. DATE OF DEATH 1MBER Attach a copy of the deed for real estate. % OF DECD'S EXCLUSION VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE ~' SANDRA S. HENRY, SURVIVING SPOUSE -ANNUITY 16,198.79 100 16,198.79 PART Z TOTAL $ $ $ 16,198.79 TOTAL (Also enter on Line 7, Recapitulation.) $ 16,198.79 (If more space is needed, use additional sheets of paper of the same size) REV-lSl3 EXt{O(-lp~ Pennsylvania SCHEDULE ~ UF: PARI~MEN7'GF REVENUE INtIERITANCE TAX RETURN BENEFICIARIES RISIDI_NT DECEDENT ESTATE OF: CHARLES A. HENRY NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under uo Not List Trustee(s) Sec. 9116 (a) (1.2).] 1~ SANDRA S. HENRY, 539 BRIDGEVIEW DRIVE, LEMOYNE, PA SPOUSE 2. DOROTHY MORRIS, 694A JULIE CT., MECHANICSBURG, PA SISTER 3. VIRGINIA ROLLINS, 2100 BENT CK. BLVD., STE. 247, MECHANICSBG SISTER FILE NUMBER: 21-11-0741 AMOUNT OR SHARE OF ESTATE RESIDUE 25,000 25, 000 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, .I APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size. ~ LAST WILL AND TESTAMENT OF CHARLES A. HENRY C~ o0p~7 I, CHARLES A. HENRY, of Lemoyne, Cumberland County, Penns Iv of sound and disposing mind, memory and understandin do y ania, being declare this as and for my Last Will and g' hereby make, publish and Testament, hereby revoking all other Wills and Codicils heretofore made by me. ~~. a FIRST I direct the payment of my just debts and expenses of my last illness a from my estate as soon after my death as convenient) ma nd funeral Y y be done. Further, I authorize my personal representative to expend funds from for the inscription of m y mY estate y grave marker which is ahead in place..'. i she survives me by thirty (30) days. If my wife, SANDRA S. HENRY not so survive me, then I direct m ~ shall y personal representative to distribute such items of tangible personal property which I inherited from my said wife amon her I far as possible according to their individual preference g oved ones, as s, including but not limited to the following family and friends: Marianne Wohlfarth; Elaine Wilson; Kitt y McClain; and Peggy Wohlfarth, if they survive me. Any such items not disposed of b shall be sold and the proceeds added to the residue of m y the forgoing y estate. SE-- CpN~ I .bequeath all of my household goods, furniture, furnishin gs and personal effects.; in accordance with a written list made by rne. during _my lifeti>ne. In the or designation on the list, then I bequeath such ite absence.af a ist ;-;.,: ms to my beloved wife, SANDRA S, HENRY 'f THIRD If my beloved wife, SANDRA S. HENRY, survives me by thirt 30 Y ( )days, then - (A) (give and bequeath the sum of twenty-five thousand ($25 00 each of my brothers and sisters who survive m 0'00) Dollars to e. JOSEPH W. HENRY; VIRGINIA HENRY ROLLINS; DOROTHY HENRY MORRIS and SHIRLEY Provided, that the foregoing bequest to JOSEPH HENRY 1NOLFE. W. HENRY shall be void, in the event that he is receiving Medical Assistance (Medicaid) benefits at the ti my estate. me of distribution of (B) I give, devise and bequeath all the rest, residue and remainde to my beloved wife, SANDRA S. HENRY. r of my estate FO--_ H In the event that my wife, SANDRA S. HENRY, .fails to , survive me by thirty (3Q) days, then I give, devise and. bequeath all the .rest, residue and rem , amder, of my estate as fbllows~ , (A) ~ I give, devise and bequeath the net proceeds of the-sale of known as 539 Bridgeview Drive, Lemoyne, Pennsylvania mY °realestate wife, after deduction of a proportionate s which I inherited from my hare of the debts, funeral expenses and costs of the administration of my estate, in three equal shares, unto t BRANCH of the HUMANE SOCIETY, the HEL he EAST SHORE EN KRAUSE ANIMAL FOUNDATION and the RSPCA, for the care of abandoned animals. (B) All the rest residue and remainder of my estate I ive bequeath, as follows: g devise and 2 (i) Eighty (80%) Percent to be divided equally, per capita and not stirpes, among the fotlowin per g persons who survive me: JOSEPH ut/, HENRY; VIRGINIA HENRY ROLLINS; DOROTHY HENRY MORR SHIRLEY HENRY WOLFE, MARILYN WOLFE IVIa IS, cKAVAGE, gNTHONY WOLFE, Jr. AND LEONARD MORRIS, Jr. Provided, that the fore o' bequest to JOSEPH W. HENRY shalt be void, in th g mg e event that he is receiving Medical Assistance (Medicaid) benefits at the time of distribution of my estate. (ii) Twenty (20%) Percent to be divided equally among the follow' mg persons or their issue, per stirpes: HARRY ROLLINS, Jr., JUDITH ~,, ROLLINS SCHULLER, STEPHEN ROLLINS and DOUGLAS MORRI S. FIFTH If my:wife survives me; I direct that no inheritance tax ~shal f be apport)oned to, her share of my estate.. If she fails to survive me, then ~ :direct that any: and ati estate, and transfer taxes imposed upon my estate as ' mhentance, P smg under this Wili- or otherwise shall be paid as an administrative expense, without apportionment out of my residuary estate passing under item FOURTH of the principal (C) hereof. SIXTH In addition to the powers conferred by law, I authorize an representative acting under this instrument, in her absolute discreti y personal on: A. To retain in the form received, or to sell either at public or private sale any real or personal property; 3 B• To exercise any options to subscribe for stocks b onds, or other investments; C• To join in any plan of lease, mortgage, consolidatio reorganization or foreclosure of any corporation in which n' exchange, may hold stocks, bonds or other securities; my estate or any trust D• To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of m payment of debts or taxes, or for an Y estate, for the Y purpose of administration or distribution, for such prices and upon such terms as my personal re ~, discretion, may deem wise, and to execute presentative, in her sole and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such ter representative in her sole discretion rna ms as my personal. ~ Y deem wise without ..the necessit obtaining any.. court a Y of : pproval #hereof; ,, . F• 'To' make distribution hereunder either'in da . sh ,or kind; ~as my;petsonal representative in her discretion° may deem wise.. , SEVENTH I do hereby nominate, constitute and appoint my wife, SAN act as Executrix of this my Last Will and Testame BRA S• HENRY, to nt. Provided, however, that if she is unwilling or unable to act as Executrix, I direct the duties of Exe cutnx to be perto-med by MARILYN W. MacKAVAGE. My personal representati reasonable compensation for the value of her service Ve shall be entitled to s to my estate. 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, CHARLES A. HENRY, Thomas E. Flower and Testator and witnesses, respectively whose names are si ned ~~ ~ the attached instrument, being first duly sworn, do hereby declare to the foregoing or authority that the Testator signed and executed the instrument as the undersigned Testament and that he signed willingly and that executed as his fr his Last Will and for the purposes therein expressed, and that each of the witnes ee and voluntary act and hearing of the Testator signed the Will as witnesses and that t knowledge the Testator was at the time eighteen 1 ses, m the presence mind and under no constraint or undue influence. o the best of their ( 8) or more years of age, of sound ~~ CHARLES A. HENRY fitness ~..._ it ess Subscribed, sworn to and acknowledged before me by CHARL the Testator, and subscribed to and sworn or affirmed to befor ES A• HENRY, Flower and ~~ ~, e me b ~~--~" ,witnesses, thi~~ day o f -- Y Thomas E. 'y , 2010. NWE'ALTH OF P N8.1'LVANIq Yvonne s°~~~ry Publ~ Carrlp HIII Boro, CumbedllrW MY Commleslon FMb f~O der, P°'~ Aasodatlon of NoEarys 6