HomeMy WebLinkAbout05-09-12 (3)
1505610140
REV-1500 ~` (°'-'°'
PA Department Of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes
PO sox 2ti0801
INHERITANCE TAX RETURN County Code Yeer File Number
Harrisburg, PA 17128-0601
RESIDENT DECEDENT 2 1 1 0 0 8 9 7
ENTER DECEDENT INFORMATION BELOW
SOCial Security Number Date Of Death MMDDYYYY Date Of Birth MMDDYYYY
2 1 0 2 6 6 7 3 4 0 8 1 7 2 0 1 0 0 8 0 1 1 9 3 2
Decedents Last Name Suffix Decedent's First Name MI
H E N R Y J O Y C E L
(If Applicable) Error Surviving Spouse's Informatton Below
Spouse's Last Name Suffot Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1.Original Retum 0 2. Supplemental Retum ~ 3. Remainder Return (date of death
4. Limited Estate
~
4a. Future Interest Compromise (date of prior to 12-13-82)
~ 5. Federal Estate Tax Retum Required
death after 12-12-62)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attadt Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COLLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX gIFORMATKNI SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3
REGISTER OF WILLS USE ONLY
First line of address
I R W I N 8 M c K N I G H T P C~ ~
Second line of address ~~ ~,.~"-
r- ~ -r t - it
6 0 W E S T P O M F R E T S T R E E T ~_ ~ ~l~'
City or Post Office State ZIP Code ~i4TE FILED ~ .: -
C A R L I S L E P A 1 7 0 1 3 ~~ ~ -_ ~:
r_ R7
(~ `~
Corresponderrt's small address: ~
Under penalties of perjury, I declare that I have examined thls return, including accompanying schedules and statements, and to the hest of my knowledge and belief,
it is true, co and complete. Declaretion of preparer other than the peroonal representative is basetl on all infonnatlon of which preparer has any knowledge.
SIGNATU F PERSON RE OR FILING RETURN
ADDRESS DATF„- /~
100 FLINTSTONE DRIVE NEWVILLE PA 1`7241
SIGNATURE ARER OTHER HAN REP SENTATNE D TE
ADDRES ' ! ~ / ~
60 WEST PO RET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J ~~
150561D240
REV-1500 EX
Decedents Social Security Number
Decedents Name: JOYCE L• HENRY 2 1 0 2 6 6 7 3 4
RECAPITULATION
1. Real Estate (Schedule A) ..................................... .... .. 1.
2. Stocks and Bonds (Schedule e) ................................ .... .. 2. 2 8 5 3 • 1 8
3. Closely Held Corporation, Partnership or Soie-Proprietorship (Schedule C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) .................... .... .. 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5. 2 5 D 7 6 , 3 9
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6.
7. Inter-Vivos Transfers & Miscellaneous N -Probate Property
(Schedule G) ~] Separate BiAing Requested . .... .. 7.
8. Total Grass Assets (total Lines 1 through 7) ..................... .... .. 8. 2 7 9 2 9 , 5 7
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 5 3 D . D 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10.
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 5 3 0 . 0 D
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 2 7 3 9 9. 5 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............... .... .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ................ .... .. 14. 2 7 3 9 9 . 5 7
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)x.o _ 0. 0 0 15. 0. 0 0
16. Amount of Line 14 to ble
at lineal rate X .o 2 7 3 9 9 . 5
7
1s.
~ ~ 3~,~~.8 :--8-~
17. Amount of Line 14 taxable
O
D
0
17
0
0
0
.
at sibling rate X .12 . .
18. Amount of Line 14 taxable
D
D
D
D
D
D
.
at collateral rate X .15 18. .
19. TAX DUE ......................................................19.
20. FILL iN THE OVAL IF YOU ARE REt,UEBTING A REFUND OF AN OVERPAYMENT
D• 0 D
Side 2
1505610240 1505610240
REV-15D0 Ex Page 3
Decedent's Complete Address:
File Number
21 10 0897
DECEDENTS NAME
JOYCE L. HENRY
STREET ADDRESS
100 FLINTSTONE DRIVE
CITY
NEVWILLE STATE
PA 21P
17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments -
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + 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.
(1) ~~ ~ 3~. ~ too
Total Credits (A + B) (2) 0.00
(3)
(~) ,00
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: Yes No
a. retain the use or inr~me of the property transferred : ........................................................... ........... ^ ^X
b. 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? ............................................ ........... ^ ^X
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................ ........... ^ Q
3. Did decedent awn an "intrust for' orpayable-upon-death bank account or security at his or her death? ......... ^ ^X
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a benefiaary designation? .........................................................
.............................. ^
........... 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YE5, 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 Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)].
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 percent
[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 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 21 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 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 decedents lineal beneficiaries is 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 decedents siblings is 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.
REV-1503 EX + (6-99)
SCHEDULE B
CoMn~NWEALTH OF PENNSYLVANIA STOCKS ~ BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
w i w i c yr FILE NUMBER
JOYCE L. HENRY 21 10 0897
AN property jointly-owned with right of aurvHorehip must bs dleclesed on Schedule F.
ITEM VALUEAT DATE
NUMBER DESCRIPTION OF DEATH
1. COMPUTERSHARE -131 SHARES OF PRINCIPAL FINANCIAL GROUP, INC. STOCK 2,853.18
131 X $21.78 = $2,853.18
TOTAL (Also enter on line 2, Recapitulation) ~ ;
(If mole space is needed, insert additional sheets of the same size)
REV-7508 EX+ (11-10)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, S MISC.
IRESI ENT DECEDENT URN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JOYCE L. HENRY 21 10 0897
Include the proceeds of litigation and the date the proceeds were received hY the estale.
AN property ~Y owned whh right of survivorship must be dlecbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. LINCOLN FINANCIAL GROUP -ANNUITY CONTRACT #0007566851 25,076.39
BENEFICIARY: THE ESTATE OF JOYCE L. HENRY
TOTAL (Also enter on Line 5, Recapitulation) ~ S
If more space is needed, insert additional sheets of paper of the same size
REV-1511 EX+ (10-09)
' pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
JOYCE L. HENRY 21 10 0897
Decedent's debts must 6e reported on Sclrodule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Stseet Addre~
City State T- ZIP
Year(s) Commission Paid:
y, AtromeyFees: IRWIN & MCKNIGHT, P.C.
3, Family Exemption: (If decedents address ~ not the same as daimanYS, attach explanation.)
Claimant
4.
5.
6.
7.
saeetaddresa
city state zIP
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Retum Preparer Fees:
REGISTER OF WILLS -FILING FEE
500.00
30.00
TOTAL (Also enter on Line 9, Recapitulation) I S
If more space s needed, use additional shee4s of paper of the same size.
REV-1513 EX+ (01-10)
' Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE HUMBER:
_I(1VrF I HENRY 71 1n AA97
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trusteeis) OF ESTATE
I TAXABLE DISTRIBUTIONS pn ~autrias ~sQou ~Ild~bibutions and transfers under
~''~T )(1
1, MICAHEL D. HENRY Lineal 6,849.90
8 MARION DRIVE 1/4TH REMAINDER
LANDISBURG, PA 17040
2. RANDY J. HENRY Lineal 6,849.89
661 WILLOW GROVE ROAD 1/4TH REMAINDER
CARLISLE PA 17015
3. KATHY E. LINE Lineal 13,699.78
100 FLINTSTONE DRIVE 1/2 REMAINDER
NEWVILLE, PA 17241
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ;
If nwre space Is needeD, use aaamonal snee[s m paper Ot the sarrle size.
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LAST WILL AND TESTAMENT ~_
~~-~
~ `~ '
' ~ ~ _''
.~
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I, JOYCE L. HENRY, of North Middleton Township, Cumberland C~ nty; ' ``:
Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make,
publish and declare this to be my Last Will and Testament, hereby revolting all Wills and
Codicils heretofore made by me.
1. I direct my Executrix or Substitute Executors, as the case may be, to pay all of my
debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore,
I direct that all state, inheritance, succession aad other death taxes imposed or payable by reason
of my death anal interest and penalties thereon with respect to all property composing of my gross
estate for death tax purposes, whether or not such property passes under this Will, shall be paid
by the Executrix or Substitute Executors of my estate.
2. My Executrix or Substitute Executors may, at her or their discretion, compromise
claims, borrow money, retain property for such length of time as she or they may deem proper;
lease and sell property for such prices, on such terms, at public or private sales, as she or they
may deem proper; and invest estate property and income without restriction to legal investments
unless otherwise provided hereunder.
3. I authorize and empower my Executrix or Substitute Executors to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at
public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore,
in fee simple, as I could do if living. My Executrix or Substitute Executors is/are authorized and
empowered to engage in any business in which I may be engaged at my death, for such period of
time after my death as seems expedient to said Executrix or Substitute Executors.
4. I give, devise and bequeath all of my estate of whatever nature and wherever situate as
follows:
a One-Fourth (1/4) to my son, MICHAEL D. HENRY, and if he
not living, to his children, share and share alike;
b. One-Fourth (1 /4) to my son, RANDY J. HENRY, and if he is
not living, to his children, share and share alike; and
c. One-Half (1/2) to my daughter, KATHY E. LINE, and if she is
not living, to her children, share and share alike.
5. I hereby direct that KATHY E. LINE and HARRY E. LINE shall be the Guardians
of my son, ANDREW F. HENRY.
6. If ANDREW F. HENRY is not living at the time of my death, all of my estate shall
be divided between MICHAEL D. HENRY, RANDY J. HENRY and KATHY E. LINE,
share and share alike.
7. I nominate and appoint KATHY E. LINE to be the Executrix of this my Last Will
and Testament. In the event she has predeceased me, failed to qualify or is not able or does not
serve for whatever reason, I then appoint MICHAEL D. HENRY and RANDY J. HENRY to
be the Substitute Executors of this my Last Will and Testament, whereby the said Substitute
Executors shall have the same powers as are given to the original Executrix hereunder.
2
___
8. No person(s) shall benefit hereunder unless such beneficiary shall su-vive me by sixty
(60) days.
9. No Executrix or Substitute Executor acting hereunder shall be required to post bond or
enter security in this or any other jurisdiction.
10. No beneficiary may assign, anticipate or pledge his or her interest in any income or
principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or
otherwise reach any such interest.
11. I hereby suggest that my personal representative retain the services of Irwin &
McKnight as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this •'~ ~ day of
May, 2007.
(SEAL)
YCE L. Y
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament, in our presence, who, at her request, in her presence and in the presence of
each other have hereunto set our names as subscribing witnesses.
3
ACKNOWLEDGMENT AND AFFIDAVIT
WE, JOYCE L. HENRY, KAREN S. NOEL and SHARON L. SCHWALM, the
Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the inst<ument as her Last Will and that she had signed willingly, and that she executed
it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their
knowledge the Testatrix was, at that tune, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
" SHARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by JOYCE L. HENRY, the Testatrix
herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L.
5CHWALM, witnesses, this i8 ~ day of May, 2007.
~•
Nakary Pnblic
~ a. iMan. rrorery wain
Carlisle Bao, Curry County
b Comrr~On ~Pires Oct 3.2008
er, Pennsylvania Aasociatian Ot Note
tpmre +
Computershare ,
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~
IMPORTANT TAX RETURN PO Box 43076
Providence, RI 02940-3078
DOCUMENT ENCLOSED Telephone: 666-761-1366
s www.ctxnputarshare.com
^ 312002
111111'11111'1'1'IIIIIli6161~11111altlllpldll~lllpllurl1111
Recipient for a change of address please call the above number or vbit us at
JOYCE L HENRY vrww.cornpulershare.com
~ 100 FLINTSTONE DR HolderAccawttNumber
s NEWVILLE PA 17241-9 700 00003091163. I N D
I~~~~~~~~ ~~
Record Data 1o Nov 2ot1
Check Number 0002470&45
OOIC80085.DObe.NG_PGI PFG.143149 17r3 120 0213 1 20W/i
Prirrci pai finanicial 6r~trp , I~tc: -2011 Gommain Stolck Qivitl~nd __
^ (~
Fenn 1099 - DN - Dhridends and Distributions 2011 COPY B -For Redpient
Thb b M1goA~M tax IMorngtlart and N tttlkrp ttatAelyd b the I11bnW Retaawa Banta. Kyau an nqu4ad p Sb a span, a twyNpnla
pamlgr or etllpsanWotl my M imposed an you M thb htcanta b talubla and tlla IRB tbbrmktaa that k tug not bean lapatad.
Racipbnt JOYCE L HENRY
100 FLINTSTONE DR
NEVWILLE PA 17241-9700
Awbnnt Number 0000~07'N03
Redpietd's ro No. ending in '°'-'~~734
Payers FederallD Na 42.1520340
OMB No. 1543-0110
Deperoront tithe Reeetey- 8eamal Reranue BnWOa
to Total OFdI tb QualHied 4 FEDERAL INCOIAE
Dividend8 ($ry Dividends (;) TAX YY-rNHELD (4) PSyer'S DStaIIS
91.70 91.70 25.66 PRINCIPAL FINANCW. GROUP INC.
GO COMPUTERSHARE
PO BOX 43010
- _ PROVIDENCE RI 02040.3010
Form 1099-DN
Vlsft 1+rww.principal.com-dhridend or ca11800-521-1502 for more information about this dividend.
Confirmation of Holdings as of 11/10/2011
Payment Date Class of Stock Record Date Dividend Grose Deduction Deduction Net
Shares I Rate I Dividend (;) Amoutn (;) Type ( Dividend (;)
D2 Dec 2011 COMMON 131 x0.70 91.70 25.68 Fed Backup Wlft Tax 66.02
46UTX
P F G 'I"
011 PF70001 OOeJ3A-PP-(FPFG)
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http://finance.yahoo.com/q/hp?s=PFG&a=07&b=178tc=2010&d=07&e=17&2010&g=d 5/8/2012
Lincoln
Financial Group
May 3, 2012
ROGER B IRWIN
IRWIN & MCKNIGHT, P.C.
60 WEST POMFRET STREET
CARLISLE PA 17103-3222
PO Box 7880
Fort Wayne, IN 46801-7880
RECEIVED
MAY 0 5 2012
IRWIN & McKrHGHT
LAW OFFICES
RE: Joyce L. Henry
The Lincoln National Life Insurance Company
Contract/PolicyNnmber 0007566851
Claim Number 740069
Dear Mr. Irwin:
We are pleased to advise that payment of benefits has been processed.
In response to your letter dated April 24, 2012, the value as of the date of death August 17, 2010
was $25,076.39. The contract was owned by the deceased, Joyce L. Henry. It was established
January 23, 1995.
Thank you for the opportunity to be of service. if you have any questions, please contact us in
writing or call toll free (800) 454-6265, ext. *8200.
Sincerely,
Karen H Brown
Claims Examiner
Greensboro Claims Department