HomeMy WebLinkAbout03-0771PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
., Deceased.
Social Security No. o~ Oq- C7 ~ -
Register of Wills for the
County of
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or,older an thc exe0cut
in the last will of the above decedent, dated id ~/_Z. -
and codicil(s) dated ~ ot~0'a; ~ -
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
D~ec end el~at sT~Samd ~l~n '~1; rdi natc dp~trhe ~ld ~l~t?~ ~.~/> _County, Pennsylvania, with
h~ i en Z~ov/~ /~,~.;
(list street, number and muncipality)
Ve~enaen~t~e. 7t _ years orate, aie~ Z,~c ~ .~ ,~ ~a~,
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the~U~ffered for probate; was not the victim ora killing and was never adjudicated
incomp~ent:~/~ ·
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s)t__he probate of the last will and codicil(s)
presented herewith and the grant of letters 7'-~'6./~-~A/7',4/~21/
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA -I
COUNTY OF ~m~r'\*.~[ ~ ss
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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed { ~?OM/,'~- - ~'
beefore me this ~' iCt~')t~ dayof :'~/'f'~z~'~'~' J'TZ~~ ~
C~ -~gister
Estate0-f'~51c~Oc~cci 0~ ~rqe~
DECREE OF PROBATE AND GRANT OF LETTERS
, Deceased
AND NOW
I
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be a~l~itted to probate and filed of record as the last will of
and Letters -~£ ~'X'c~r-r,e,~rr~-~ \
are hereby granted tokb~wo~'c-~~ 0._. x~k.erxa~
, in consideration of the petition on
FEES
Probate, Letters, Etc .......... $ L~D .CO
Short Certificates( ) .......... $
~,~aaa~n ~..~ ~... $.
~ $ io.oo
TOTAL ~ $ Lo~ . O0
Filed .~ r ~..~..~ ~ ......................
Register of Wills
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
009773-00001/January 13, 1995/RWS/PAR/40895
OF
RICHARD C. HENRY
I, RICHARD C. HENRY, of 5223 Royal Drive, Mechanicsburg, Cumberland County, Pennsylvania,
make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and
all Wills by me at any time heretofore made.
ITEM I: I direct the payment of all my legal debts and funeral expenses as soon after my death as
may be convenient for my Executrix hereinafter named.
ITEM II: I devise and bequeath all of my tangible personal property, together with all insurance
thereon to my wife, VERONICA C. HENRY, providing she shall survive me by thirty (30) days.
ITEM III: I devise and bequeath all the rest, residue, and remainder of my estate of every nature
and wherever situate to my Wife, VERONICA C. HENRY, providing she shall survive me by thirty (30)
days.
ITEM IV: Should my wife, VERONI.,CA C. HENRY, predecease me or die on or before the
thirtieth (30th) day following my death, I devise and bequeath all the rest, residue, and remainder of my estate
of every nature and wherever situate to be divided equally between my children as follows:
A. One-third (1/3) to my son, ROBERT J. HENRy;
B. One-third (1/3) to my daughter, EILEEN M. ANDREWS; and
C. One-third (1/3) to my daughter, PATRICIA L. BEAR.
009773-00001/January 1~, 1995/RW$/PAR/40895
Should any of my above named children not be living on the thirty-first (31st) day following my death, I
devise and bequeath his or her share of my estate to his or her issue, per stirpes, living on the thirty-first
(31st) day following my death, and in default of such issue then living, his or her share of my estate shall be
added to the shares for the other named persons or their issue.
ITEM V: I appoint DAUPHIN DEPOSIT BANK and TRUST COMPANY guardian of any
property which passes either under this Will or otherwise to a minor with respect to which I am authorized
to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian
shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor
or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income
from time to time for the minor's support and education (including college education, both graduate and
undergraduate and trade school) without regard to his or her parent's ability to provide for such support and
education or to make payment for these purposes without further responsibility to the minor or to the minor's
parent or to any person taking care of the minor.
ITEM VI: I nominate, constitute and appoint my wife, VERONICA C. HENRY, Executrix of this,
my Last Will. Should my wife, VERONICA C. HENRY, fail to qualify or cease to act as Executrix, I
nominate, constitute and appoint my son, ROBERT J. HENRY, Executor of this, my Last Will. If he fails
to qualify or ceases to act as Executor, I nominate, constitute and appoint my daughter, EILEEN M.
ANDREWS, as Executrix of this, my Last Will.
ITEM VII: I direct that my Executrix shall not be required to give bond for the faithful performance
of her duties in any jurisdiction.
IN WITNESS WHEREOF, I, RICHARD C. HENRY, have hereunto set my hand and seal this
day of ~ b,-~,~ .- ¥- ,1995.
RICHARD C. HENRY
(SEAL)
009773-00001/~anuary 13, 1995/RWS/PAR/40895
SIGNED, SEALED, PUBLISHED AND DECLARED, by RICHARD C. HENRY, the Testator
above named, as and for his Last Will and Testament and in the presence of us, who, at his request, in his
)resence and in the presence of each other, have subscribed our names as witnesses.
Witness
Address
?
Address
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF CUMBERLAND :
I, RICHARD C. HENRY, Testator, whose name is signed to the foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the instrumem as my Last
Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
RICHARD C. HENRY
Sworn to or affirmed and acknowledged before me, by RICHARD C. HENRY, the Testator, this
~t~day of ~.~1 ~L~(/r , 1995.
' ' NOTARIAL SEAL ....
SHARON L. RUD¥, Notary Publl~
Lemo~o Bore. Cumberland Courtly
My Commission Expires Mar. 2,4~ 19~,
Notary Publ~' ~..
My commission expire
(SEAL)
009773-00001/$anuary 13, 1995/RWS/PAR/40895
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF CUMBERLAND :
the foregoing instrument, being duly qualified according toq~w, do depose and say that we were present and
saw the Testator sign and execute the foregoing instrument as his Last Will and Testament; that he signed
willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge,
the Testator was at that time at least 18 years of age, of sound mind and under no constraint or undue
influence.
Sworn to or affirmed
]/f]~Je/.//ff //{:/, witnesses, this~C/¢~day of
and subscribed to before me by ff./(/]fi/y:/ t(~J. X._~~
~'~/~.~/~..// ,1995.
Notary Public - d
My commission expires:
(SEAL)
SHARON L. RUDY, Notarv Publlo I
Lernoyrm Bom. Cumberland Courtly I
My Co~m)lsston Expires Mar. 24, lg98 !
5 ill
OF
Richard W. Ste~-t, Esquire
JOHNSON, DUFFle, STEWART
& WEIDNER
ATTORNEYS AT LAW
LEMOYNE. PENNSYLVANIA
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. ZB0601
HARRISBURG, PA 171Z8-0601
REV-l$45 EX &FP (O9-OD)
VERONICA C HENRY
5225 ROYAL DR
MECHANICSBURG PA 170~5-5515
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
EST. OF RICHARD C HENRY
S.S. NO. 20q-OS-6251
DATE OF DEATH 06-09-Z005
:i!i~COUNTY CUMBERLAND
J FILE NO. Zl-~
ACN 0515q195
DATE 09-25-2005
TYPE OF ACCOUNT
[] SAVINGS
[] CHECKING
[] TRUST
[] CERTTF.
REHTT PAYNENT AND FORNS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
ALLFZRST DANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of tho above decedent, you were s joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain orittan correction from the financial institution, attach a copy
to this ~orm and return it to tho above address. This account is taxable in accordance with tho Inheritance Tax Leos of the Commonwealth
of Pennsylvania. Questions lay be ansaered by calling (717) 787-BSZ7.
COMPLETE PART I BELOH x x x SEE REVERSE SiDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. OOq229755q Data 07-Z8-197q
Established
Account Balance 1Z~505.55
Percent Taxable X 50.000
Amount SubSact to Tax 6,151.67
Tax Rata X .15
Potential Tax Due 922.75
To insure proper credit to your account, tho
(g) copies of this notice must accompany your
payment to the Register of gills. Make check
payable to: "Register of gills, Agent".
NOTE: If tax payments are mode within three
(5) months of the decedant's date of death,
you moy deduct a 5Z discount of the tax due.
Any inheritance tax due mill become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
CHECK
ONE
BLOCK
ONLY
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of gills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
gills and an offJcia! assessment cji! be Jssuad by the PA Department of Revenue.
PART Zf you indicate a different tax rat~tata your
relationship to decadent: _
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
B. [] The above asset has been or will be reported and tax paid oith the Pennsylvania Inheritance Tax return to ba filed by the decadont's representative.
C. ~/The above information is incorrect and/hr ra--~-~-: =:.~ ~f.,rfinn~ uae. p.~a ~=- :-::.
~'~ou must ce.plate PART ~ and/or PART ~ be~o,.
2 ~a~ ~o3,33 ................... . .............
LINE 1. Data Established
2. Account Balance
~ Percent Taxable
q. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rata
8. Tax Due
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
(Enter on Line $ of Tax Computation) $
~/ I 'Under panaltias of par:lury, Z declare that tho facts T have reported above ara true, correct and
co,plata tq tho bast.o~f ay know.lodge and belief. HOME (-')1"7) ~7~(~-c~1 ~
TAXPAYER SIGNATURE ~r TELEPHONE NUMBER DATE
GENERAL ZNFORHATZON
1. FAILURE TO RESPOND NILL RESULT ZN AN OFFICIAL TAX ASSESSHENT alth applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after tho dacadant's date of death.
$. A joint account is taxable even though the dacadent's name ems added as a matter of convenience.
~. Accounts (including those haZd bataean husband and alfa) ehich the decedent put in joint names within Dna year prior to
death ara fully taxable as transfers.
S. Accounts established jointly between husband and wife aero than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another ar others ara taxable
REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice ara correct and deductions ara nat being claimed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check far the amount of
tax to the Register of NiI1s of the county indicated. The PA Department of Revenue will issue an official assessment
(Fora REV-]S~8 EX) upon receipt of the return from the Register of Rl]]s.
Z. BLOCK B - If the asset specified on this notice has been or mill be reported and tax paid aith the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt ZB060l, Harrisburg, PA ITIZB-060I in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and $
according to the instructions be]ow. Sign two copies and submit them ,tth your check for the amount of tax payable to the Register
of #ills of the county indicated. The PA Department of Revenue ail1 issue an official assessment (Fora REV-]5~O EX) upon receipt
of the return from the Register of #ills.
TAX RETURN - PART Z - TAX COFIPUTATTON
L
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE= For a decedent dying after II/II/BI.- Accounts ahich the decedent put in joint names within Dna (I) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $5,000 par transferee regard]ess of the value of
the account or the number of accounts held.
If a double asterisk (ix) appears before your first name in the address portion of this notice, the S5,000 exclusion
already has been deducted fro=' the account balance as reported by the financial institution.
Enter the total balance cf the account including interest accrued to the date of death.
The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decadant's death:
1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE
JOINT O#NERS SURVIVING JOINT ONNERS
ExaapZa: A joint asset registered in tho name of tho decedent and two other parsons.
! DIVIDED BY 3 (JOINT O#NERS) DIVIDED BY 2: (SURVIVORS) = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR)
B,Tho percent taxable for assets created within one year of tho dacadant's death or accounts owned by the decedent but hold
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established eithln one year of death by
the decedent.
I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line ~) is determined by multiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) ia determined by subtracting the debts and deductions (line 5) from the amount subject to tax (]ina ~).
7. Enter the appropriate tax rata (line 73 as determined heleN.
Da{e of Dee{h I Spouse Lineal I Sibling Cella{era1
07/01/94 ~o 12/31/94 SX 6Z 15X 15Z
01/01/95 ~o 06/30/00 OZ 6X 15Z 15Z
07/01/00 ~o presen~ OZ 4.Six 12Z 15Z
NTho tax rate imposed on the net value of transfers free a deceased child twenty-Dna years of age or younger at
death to or for tho usa of a natural parent, an adoptive parent, or a stapparent of the child is
Tho lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all chlldren of the
natural parents and thelr descendents, whether or not they have bean adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at Least one parent in common wlth the decedent, whether by blood
or adoption. Tho "Collateral" class of heirs includes ail other beneficiaries.
CLATNED DEDUCTTONS - PART :5 DE]iTS AND DEDUCTZONS CLATNED
Allowable debts and deductions ara determined as
A. You legally are responsible for payment, or tho estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actua]]y paid the debts after death of the decedent and can furnish proof of payment.
C. Debts belng claimed must be ltealzed fully in Part 3. If additional space ]s needed, usa plain paper 8 l/Z" x 11". Proof
payment may be requested by the PA Department of Revenue.
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARR/SBURG, PA 171Z8-0601
REV-I$~S EX AFP COD-iD)
VERONICA C HENRY
5225 ROYAL DR
HECHANICSBURG PA 17055
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
FZLE NO. 21-~-'2 ~/
ACN 0315q196
DATE 09-23-2003
EST. OF RICHARD C HENRY
S.S. NO. 20q-O3-GZ51
DATE OF DEATH 06-09-Z003
~,ilCOUNTY CUMBERLAND
TYPE OF ACCOUNT [] SAVINGS
[] CHECKING
[] TRUST
[] CERTIF.
REHIT PAYHENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ALLFZRST BANK has provided the Department aith the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death o~ the above decedent, you Norm a joint owner/beneficiary of
this account, if you faa1 this information is incorrect, please obtain mrittan correction fram the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance mith tho Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW x x x SEE REVERSE SIDE FOR FILING AN]} PAYMENT iNSTRUCTIONS
Accoun* No. 8700~919715781 Date 07-$1-197~
Established
Account Balance 21,637.2~
Percent Taxable X 50.000
Amount Subject to Tax 10,818.62
Tax Ra~e X .15
Potential Tax Due 1,622.79
To lnsure proper credit to your account, tho
(Z) copies of this notice oust accompany your
payment to the Register of Nills. Hake check
payable to: "Register of gills, Agent".
NOTE: Zf tax payments ara made within three
(3) months of the dacedant's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[-q
LINE
CHECK ]
ONE
BLOCK
ONLY
TAXPAYER RESPOHSE
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain
a discount or avoid interest, or you amy check box "A" and return this notice to the Register of
)dills and an official assessment gill ba issued by the PA Department of Revenue.
B. ~ The above asset has been or Nil1 be reported and tax paid Nith the Pennsylvania Tnharitanca Tax return
to be filed by the decadant's representative.
C. ~/The above information is incorrect and/e~ d...~s-"ana ~Vou must complete PART ~ and/or PART ~ baloN.
zf you indicate a different t~x~rata, please state your
relationship to decedent: .~ c~-e~
RETURN -COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
Account B.lance 2 ~, ~.~)~
~$,)Percent Taxable 3 X 0
q. Amount Subject to Tax q 0
E. Debts and Deductions 5. -
6. Amoun~ Taxable 6 ~
7. Tax Ra*e 7 ~ ~
8. Tax Due 8 ~
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
/ ~-~TOTAL (Enter on Line S of Tax Computation) $
of perjury, Z dacla~'l'e,~hat Z have reported above are ~rue, and
/-. Under perm es
facts
corr'ec~
~X ~p'/y~~ C- WORK
ER SIGNATURE TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSHENT .ith appLicable interast based on information
submitted by fha financial institution.
2. Znharitanca tax becomes delinquent nine months altar the docodant's date of death.
3. A joint account is taxable even though the docadant's name ems added as a mattar of convanJanco.
q. Accounts (including those held batNaan husband and aifo) ahich fha decedent put in joint names within one year prior to
daath ara fully taxable as transfers.
5. Accounts established jointly bat.eon husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" anothar or others era taxable ~ully.
REPORTING INSTRUCTIONS - PART I TAXPAYER RESPONSE
1. BLOCK A - If the information end computation in the notice are correct and deductions are not being claimed, place an
in block WA" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount
tax to the Register of Nills of the county indicated. The PA Department of Revenue #ill issue an official assessment
(Form REV-lSq8 EX) upon receipt of tha return from the Register of Hills.
Z. BLOCK B - If the asset specified on this notice has been or will bm reported and tax paid with tho Pennsylvania Inheritance
Tax Return filed by the dacadant's representativa, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign Dna
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oapt 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - [f the notice information is incorrect and/or deductions ara being claiaad, check block "C" and complete Parts Z and
according to the instructions boloN. Sign two copias and submit thee Nith your check for the amount of tax payable to the Rag[star
of #ills of fha county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lO48 EX) upon receipt
of the return from tha Register of Hills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originaLly was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which fha decedent put in joint names within one (1) yaar of death ara
taxable RJIly as transfers. However, there is an axclusion not to exceed $3,000 per transfarea regardless of tha va[ua of
the account or the number of accounts held.
Ife double asterisk (aw) appears baforo your first name in tho address portion of this notice, the S3,000 exclusion
already has been deducted from tho account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the data of death.
3. Tho percent of tho account that is taxable for each survivor is determined es foLloas:
A. Tha percent taxable ~or joint assets established more than one year prior to the decadant's death:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE
JOINT OHNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decadent and tad other parsons.
I DIVIDED BY 3 (JO[MT OHNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.77. (TAXABLE FOR EACH SURVIVOR)
B.The percent taxable ~or assets created within Dna year of the dacedant's death or accounts ownad by tho decedent but hold
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
ONNERS OR TRUST BENEFTCTARIES
Example: Joint account ragJstored in tha name of the decedent and two other persons and established within Dna year of death by
the decedent.
I DXVTDED BY 2 (SURVTVORS) = .SO X 100 = ROI (TAXABLE FOR EACH SURVIVOR)
4. Tho amount subject to tax (line 43 is determined by multiplying the account balance (line 2) by tha percent taxable (1ina 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting tha debts and deductions (line 5) from the amount subject to tax (line
7. Enter the appropriate tax rate (line 73 as datarmined bale,.
Date of Death Spouse Lineal Sibling Collateral
07/01/9q to 12/$1/9q
01/01/95 to 06/30/00 OX 6Z
07/01/00 to present OX
xThe tax rate imposed on tho net value of transfers from a deceased child t.enty-one years of age or younger at
death to or for the use of a natural parent, an adoptive parent, or e stepparont of the child is OZ.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
ahether or not they have been adopted by othars, adopted childran and stap chJldran. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
end step-descendants. "Siblings" ara defined as individuals who have at least one parent in common with tho decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other bonaficiarios.
CLATMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED
Allo~ebla debts and deductions ara datarminod as follows:
A. You legally are rasponsiblo for payment, or fha estate subject to administration by a personal represantetive is insufficient
to pay the daductibla items.
B. You actually paid the debts after death of tho decedent and can furnish proof of payment.
C. Debts being claimed must ba itemized fully in Part 3. If additional space is needed, use plain paper a l/Z" x SI". Proof of
payment may be requested by tho PA Department of Revenue.
~EV-1500 EX
,COMMONWEALTH Of
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-I$O0
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFiCiAL USE ONLY
COUNTY CODE YEAR NUMBER
I--
Z
LU
UJ
uJ
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
i ~"~. Original Return
[~4. Limited Estate
r'--'~ 6. Decedent Died Testate (Attach copy of Will)
I-'--'l 9. Litigation Proceeds Received/'
' '[--] 2. Supplemental Return
E~4a. Future Interest Compromise (date of death after 12-12-82)
[~7. Decedent Maintained a Living Trust {Attach copy of Trust)
E~]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
NAME ~k~j~rOf~\L/ ~J~y_~
FIRM NAME (IfApplicable) / ~
TELEPHONE NUMB~
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1~3. Remainder Return (date of death prior to 12-13-82)
[~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (Attach Sch O)
1. Real Estate (ScheduleA) (1)
COMPLETE MAILING ADDRESS
OFFICIAL USE ONLY
< 8.
LU 9,
10.
11.
12.
13.
14.
Stocks and Bonds (Schedule B) (2)
Closely Held Corporation, Partnership or 'ship (3)
Mortgages & Notes Receivable (Schedule D) (4)
Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
Jointly Owned Property (Schedule F) (6) __
E~ Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H)
Debts of Decedent, Mortgage Liabilities, & Liens, (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 6 minus Line 11
Charitable and Governmental Bec
made (Schedule J)
Net Value Subject to Tax ( ,)
(8)
an election to tax has not been
(11)
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19, Tax Due
.0_ ¢5)
.0_ (16)
.12 (17)
.15 (18)
(19)
Decedent's Complete Address:
STREET ADDRESS
CITY ~"Y~'~ ~/~ 0~ C'$ b k,k ~ STATE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
InterestJPenalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C )
O
O Total InterestJPenalty ( D + E )
I[ Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund
A. Enter the intere~n the tax due.
B. Enter the total ~sLine 5 + 5A. This is the BALANCE DUE.
z,P l'705'$
(2)
O
O
O
(3)
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
1. ,,~d decedent make a transfer and: Yes
4. retain the use or income of the property transferred; .......................................................................................... []
. retain the right to designate who shall use the property transferred or its income; ............................................ []
c. retain a reversionary interest; or .......................................................................................................................... []
d. receive the promise for life of either payments, benefits or care? ...................................................................... []
2.If death occurred after December 12, 1982, did decedent transfer property within one year of death ~
without receiving adequate consideration? .............................................................................................................. []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ~_
contains a beneficiary designation? ........................................................................................................................ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU~,E OF/PERSON RESP~)NSIBLE FOR FI~.ING RETURN
AD, E'SS" _ .. -.
DATE/
lo/3//o
SIGNATURE.OF PREPARER OTHER THAN REPRESENTATIVE DATE /
ADDRESS
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 3%
[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 0% [72 P.S. {}9116 (a) (1.1)
The statute does not 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
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 paten'
or a stepparent of the child is 0% [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%, 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 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a~
individual who has at least one parent in common with the decedent, whether by blood or adoption.
Harrisburg, PA 17128-0601
Donna Otto
Register of Wills
Cumberland County Courthouse
1 Courthouse Sq
~'.nrli~ln PA 17nl .3,
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Richard C. Henry
Date of Death:
06/09/2003
Will No. 21-2003-771 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orl~hans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~' ~ ~ ~ :
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Signature
Capacity:
Name
Address
Telephone
x Personal Representative
~Counsel for personal representative
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COHNONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF /NHERZTANCE TAX
APPRAZSEHENT~ ALLO#ANCE OR DISALLO#ANCE
OF DEDUCT/ONS AND ASSESSHENT OF TAX
VERONICA HENRY
5ZZ$ ROYAL DR
HECHANICSBURG
PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
RE¥-15~7 EX AFP (~1-D$)
12-29-2005
HENRY RICHARD C
06-09-2005
21 05-0771
CUMBERLAND
Amoun~ Raei~ed
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HENRY RICHARD CFZLE NO. 21 05-0771 ACN 101 DATE 12-29-2005
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSe.
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S*ocks end Bonds (Schedule B) (2)
$. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C) ($)
4. Hot,gages/No,es Receivable (Schedule D)
$. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E)
6. Jointly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~el Asse~s
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Cos~s/Nisc. Expanses (Schedule N) (9)
10. Deb~s/Hor~gage Liabilities/Liens (Schedule Z) (10)
11. To'al Deductions
12. Ne~ Value of Tax Re~urn
15.
14.
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Ne~ Value of Es~a~e Subjac~ ~o Tax
.00
.00
.00
.00
(8)
.00
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 submi~ ~he upper portion
of ~his fore w/ih your
~ax payment.
.O0
(11)
(12)
(15)
(14)
NOTE: Zf an assessment was issued prev/ously, lines 14, 15 and/or 16, 17, 18 and 19
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX: '
.00
.00
.00
.00
will
15. Aeoun~ of Line 14 a~ Spousal ra~e
16. Aeoun~ of Line 14 ~axable a~ Lineal/Class A ra~e
17. Amount of Line 14 at Sibling rate
16. Aeount of Line 1~ taxable at Colla~ceral/Cless B rate
19. Pr/nc/)el Tax Due
TAX CREDITS:
PAYMENT RECE/PT D/SCOUNT (+J
DATE NUHBER [NTEREST/PEN PAID (-)
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15) .00 X O0 = .00
(16) .00 X 045= .00
(17) . O0 X 12 = . O0
(18) .00 x 15 = .00
(19)~ .00
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.°°/
o00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REgUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE S~DE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inharitance Taxms
at the lawful Class B (collateral) rate on any such futura interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (?Z P.S.
Section 91~0).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
REFUND (CR): A refund of a tax credit, ehich was nat requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office
of the Register of Nills, any of the 25 Revenue District Offices, ar by calling the special 2~-hour
answering service for forms ordering: 1-800-562-Z050; services for taxpayers aith special hearing and / ar
speaking needs: 1-800-qq7-5020 (TT only).
OBJECTIONS: Any party in interest not satisfied eith the appraisement, a11oaance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Beard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election te have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZBO601, Harrisburg, PA 1712B-0601
Phone (717) 787-6505. See page 5 of the booklmt "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three [3) calendar months after the decedent's death, a five percent (SX) discount of
the tax paid is a11oaed.
PENALTY: The 152 tax amnesty non-participation penalty is camputed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after thm end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated en this notice.
INTEREST: Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the data of
death, to the date cf payment. Taxes ahich became delinquent before January 1, 19BZ bear interest at the rate of
six (BX) percent per annum calculated at a daily rate of .OOOI6q. All taxes ehich became delinquent on and after
January 1, 19BZ ail1 bear interest at a rate ehich ail1 vary from calendar year to calendar year with that rate
announced by the PA Department cf Revenue. The applicable interest rates for 1982 through 200~ are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Yea.~r Rata Factor Yea__.r Rate Factor
19BZ ZOZ .O00S~B 1987 92 .0002~7 1999 72 .000192
1985 162 .000~$8 1988-1991 IXZ .000501 ZOO0 82 .OOOZX9
198~ 112 .000501 1992 92 .000247 2001 92 .0002~7
1955 1~Z .000556 1995-199~ 72 .000192 2002 62 .00016~
1986 lOX .00027~ 1995-1998 92 .0002~7 2003 52 .000157
--Interest is calculated as follows:
/NTEREST = BALANCE OF TAX UNPA/D X NUHBER OF DAYS DBLXNQUENT X DA/LY XNTBRBST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/03/2005
HENRY VERONICA C
5223 ROYAL DR
MECHANICSBURG, PA 17055
RE: Estate of HENRY RICHARD C
File Number: 2003-00771
Dear Sir/Madam:
It has corne 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:
6/09/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
;
-
Register of Wills of Cumberland County
Date of Death:
STATUS REPORT UNDER RULE 6.12
~'e fhf,e]) C. IIctf/p<. V
I
:rilf1.Jc 9: .20CJ-3
c:(tJ 0-3 - C/o 77 /
Name of Decedent:
Estate No.:
Pursuant to Ru1e 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 ~ No 0
2~ If the answer is No, state when the personal represf!1tative reasonably believes that
the administration will be complete: AI f1!....
,
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 I81
b. The separate Orp~;Court No. (if any) for the personal representative's
account is: tV( A
c. Did the personal representative state ~ rcount informally to the parties in
interest? Yes 0 No 0 ;VI fr
c. Copies of receipts, releases, joinders and approval oHormal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
D''''4!>~
C'"')
...,~-
,~;;.-
1IJ/z~ (! -~-
Si~ture
V~eoAJ/~11- c! _ !le-/l/~y
f
Name
('\,,J
:>-
Address
Capacity: ~Personal Representative
o Counsel for personal representative
;:1. I/o..{-s-
cPP