HomeMy WebLinkAbout09-23-13 � 1505610143
REV-1500 Ex`°,_,°, �
OFFICIAL USE ONLY
PA Department of Revenue pannsylvania co�niv coae vear File Number
Bureau of Individual Taxes "t'"^•"E"*^�"�E
Po soX.zaoso� INHERITANCE TAX RETURN 21 13 0452
Harrisburg,PA 7 7 7 28-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 06 2013 07 OS 1929
DecedenYs Last Name Suffix DecedenPs First Name MI
HENRY WILL2AM D
(If Applicable)Enter Surviving Spouse's Intormation Below
Spouse's Last Name Suffix Spouse's First Name MI
HENRY FAIRI,YN C
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
�X� t Onginai Rewrn � 2. Supplemental ReNm �i 3. Pe�mao d2r'RegiZ)n(tlate of tleath
�J� n. Limited Estate � qg Puture IMereat Compromise 5. Fetlerel Estate 7ax Return Requiretl
(affie of tleetn aner 12-0232) ��
CX� E DecetlantDiedTestate � � DecetlentMein�inetlaLivingTmat 0 e. 7otalNUmberofSafeDeposi[Boxes
' (A�lachCOpyo(Willi (At�achGOpyo rusl)
�� 9. Lifigation ProCeetls ReCeived � 10 Spousal Poven Cretlit�(dete of tleem �� Ele Io tax untlef$ec 9713(A) .
�ce�ween�z-si�i�ana -i-55) � (A Sch.O) � �
� ��,
CORRESPONDEN7-THIS SEC710N MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INP�RMATION SHOULD BE DIRECTED TO:
Name Daytime Tdlepbone Number �
BRADI.EY I, GRIFFIE 717 2'43 555s�
REGISTER OF WILLS�kl8E ONLY �
c, �
Firet line of address ' . .
_ _ ,
�..> ..
200 NORTH FiANOVER STREE ° `"
Second line of address
DATE FILED
City or Post Office SWte ZIP Code
CARLZSLE PA 17013
CorrespondenYs e-mail address: bgriffle�g�Ifflelaw.COm
Under p altles of perjury,I tleclare ihat I have examined[his return,including accompanying schedules antl starements,antl to the besl of my knowletlge antl belief,
it is irue rrecf and com ete.Declaration of preparer other than the personal represeniative is basetl on all infortnation of which preparer h any knowletlge.
SIGNAT �F P N R SPONSIBLE FOR PILING RETURN ATE
Gre o W. Hen
nooaess
7 S rin V' Street Carlis PA 17013
SIGNA OF P PARER OTH N REPRESENTATIVE D TE
Bradley L Griffie �j � �
C RE55 / //
200 North Ha�ver Str , Carlisle, PA
Side 1
� 1505610143 1505610143 � � \
�WI
1 15U561�243
�
REV-1500 EX
DecedenPs Sociat Security Number
oe�tlam'sNa� Henry, William D.
RECAPITULATION
1. RealEState(SchetluleA)................................................................._.................... 7. 173 � 000 . 00
2. Stocks and Bontls(Schedule B)............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule Dj........................................................ 4.
5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 343 � 8�7 . $7
6. Jointly Owned Property(Schedule F) ❑ Separete Billing Requesietl............ 6. 1 ,327 . 39
7. Inter-Vivos Transfers&Miscellaneous l�nq-Probate Property
(Schedule G) U Separate Blllin9 Requested............ �. 20 , 052 .26
8, ToWI Gross Asseks (total Lines 1-7)..................................................................... 8. S3B ,�187 . 52
9. Funeral Expenses&Administretive Costs(Schedule H)....................................... 9. �2 6, 835 . 61
10. Debts of Decedent, Mortgage Liabilities,8 Liens(Schedule I).............................. 10. 1 , 2 96 . 0 0
11. Total Deductions(total Lines 9& 10)................................................................... ��. 2 S ,133 . 61
12. Net Value of EsWte(Line 8 minus Line 11).......................................................... �Z, 510 , 053 . 91
�3. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Taz(Line 12 minus Line 13)............................................... 14. 510 , 053 . 91
TAX COMPUTATION-SEE INSTRl1CT10NS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfars under Sec.9116 1 �3 2 7 . 3 9 15. 0 . 0�
(a)(12)X.00
16. AmountofLinel4taxable 508 726. 52 ts. 22 , 892 - 69
at lineal rate X .045 �
17. Amount of Line 14 t2xable
at sibling rate X .12 0 . �� 17. 0 . ��
18. Amount of Line 14 tazable
at collateral rate X.15 0 . 00 78. 0 . 00
19. Tax Due.................................................................................................................. 19. ZZ � 892 . 69
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �X
Side 2
� 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21-13-0452
DecedenYs Complete Address:
DECEDENT'S NAME
Henry,William D.
STREETADDRESS
822 Forge Road
CITY STATE ZIP
Carlisle PA � 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19j (1} 22,892.69
2. Credits/Payments
A. Prior Payments 22,500.00
B. Discount 1,125.00
Total Credits(A +B) (2) 23,625.00
3. Interest (3)
4. If Line 2 is greater than Line 1+Line 3,en[er the difference. This is the OVERPAYMENT. (4) 732.31
Check box 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. (5)
Make Cheok-Ra able 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: bes No
� . . . ..........:.............................................. x
a. retam the u9e or inry 9e of the propeAy trensf�rreP;...Y..._..... ... . I� ❑
b. retam the ri ht to desi nate who shall use the ro ert transferred or its mcome ......... ........... i
c. retain a revereiona interest;or.... .. ... .. ....... . . ... . �� ❑
d. receive the promise for life of either payments,benefits or care�........................................................... ❑ �
2. If death ocwrred after December 12, 1982,did decedent transfer propedy within one year of death without
receiving adequate consideration?.................................._................................................................................ I� �
3. Did decedent own an"in trust fo�' or payable upon death bank account or security at his or her death?....... I� �
4. Did decedent own an Individual Retirement Account, annuity,or other non-probate property which
contains a beneficiary designation?.........................._...................................................................................... I� ❑
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 aRer July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of trensfers 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 January 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 fiiing a tax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of tleath 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.§9176(a)(1.2)].
. The taz rate imposed on the net value of transfers to or for the use of the decedenPs lineal beneficiaries is 4.5 percent,ezcept as noted in
72 P.S. §9116 12)[72 P.S. §9116(a)(1)1.
. The tax rete imposed on the net value of transfers to or for the use of the decedenPs siblings is 12 percent[72 P.S. §9116(a)(7 3)�. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decetlent,whether by blood or adoption.
•Rev-7602 EX*(tt-0e�
SCHEDULE A
REAL ESTATE
COMMON WEALTH OF PENNSYLVRNIA
INHERITANCE TG%REfUpN
RESIDENT DECEOEM
ESTATE OF FILE NUMBER
Henry, William D. 21-13-0452
All real proparry ownetl aolely or as e tananf fn common mus[be reportatl at feir me�ket value.Feir me�kel velue is tle(inetl as�he price at whlch pmpatly woultl be
exchengad belween a willing�uyer entl a wlllin8 seller,neither being compellatl m Euy ar sall,Goth having reesoneCla knowletlge of the relevant faas.
Reel properly which is jolntly-ownatl with right of survivorebip muat be tllacloaetl on sehetlule F.
Attach a eopy of the aetllement sheet ii the proparty has been aoltl
Inclutle a copy of tha tlaetl ahovnng tlecatlanYa Interest If ownad ee tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Residential Property- 173,000.00
822 Forge Road,Carlisle, PA 17015
(See attached HUD-1 Settlement Statement)
TOTAL(Also enter on Line 1, Recapitulation) 773,000.00
Qf more space is neetled,addilional pa9es of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Fortn PA-1500 Schedule A(Rev. '11-08)
Rav�1508 E%t�6-88)
SCHEDULE E
CASH, BANK DEPOSITS, 8� MISC.
PERSONAL PROPERTY
COMMONWENLTHOFPENNSTLVANIA
INMERIThNCETR%PETURN
RESIOEIJ�DECEOENT
ESTATE OF FILE NUMBER
Henry,William D. 21-13-0452
Inclutle Ihe proceetls o!litigalion end I�e tle�e�he pmceetls were receivetl by t�e estete.
All properry jdntlpowned wIN Na nght of aurvivorahip must be tliaclosed on eehetlule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 F&M Trust Money Management-Account No. XXX7266 318,100.78
(See attached statement)
2 F8M Trust Checking Account-Account No.XXX5100 14,948.47
(See attached statement)
3 Carlisle Regional Medical Center-Refund of overpayment 272.57
4 2012 Personal Federal Income Tax refund 1,300.50
5 Personal Property Auctioned-(See attached statement) 5,923.50
6 Centurytel, Ina, refund 17.19
7 Tax Prorations credited at settlement -1,695.74
8 Travelers Insurance Premium refund(Homeowner's) 60.00
9 Subscription refund from the Sentinel 38.76
10 Advanced Disposal refund of overpayment 9.32
11 Personal Property Sold �1,367.00
12 Savings Bond- 74.04
(See attached statement)
TOTAL(Also enter on Line 5, Recapitulation) 343,607.87
Qf more space is neetletl,atldi6onal pages of the same siu)
Copynght(c)2002 form software oNy The Lackner Group, Ina Fortn PA-150D Schedule E(Rev. 6-98)
Rev-0b09 EXi(6-98)
SCHEDULE F
�oMMO„,�,,�r„oF,E�„sY,_�aN,p JOINTLY-OWNED PROPERTY
INHERRqNCETAXRETUHN
RESI�ENTOECEDENT
ESTATE OF FILE NUMBER
Henry, William D. 21-13-0452
Ii an aeaet was matle jolnt within one year o/the tlecetlenPS tlate ot tleeN,it muet ba reponetl an achetlule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Fairlyn C. Henry(Deceased Claremont Nursing and Rehab Center, Wife
8122/13) 1000 Claremont Road
Carlisle, PA 77015
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF�EA7H
ITEM LETTER DATE INCLU�E NAME Oi FINANCIAL INSTRUTION AND BANKACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATfACH DEED FOR VALUE OF ASSE INTEREST OECE�ENT'S INTEREST
TENANT JOINT Jp�NTLY-MEID REAL ESTATE.
1 A 01/03I2006 Members�1st FCU Savings Account-Account 36.77 50.000% 18.39
No.XXX769-00
(See attached statement)
2 A 04/08/2009 Members 1st FCU Savings Account-Account 15.00 50.000°/, 7.50
No.XXX770-00
(See attached statement)
3 A 01/03I2006 F&M Trust Checking Account-Account No. 2,602.99 50.000% 1,301.50
� ��XXX58W0
(See attached statement)
TOTAL(Also enter on Line 6, Recapitulation) 1.327.39
Qf more space is neetleQ additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Ina Form PA-1500 Schedule F(Rev.6-98)
Revd 510 E%+(6-98�
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
CqAMON W EA�TH OF PE NNSYLYqNIN
INMEftITANCETAXRETOpIJ
RESIDENTDECEDEM
ESTATE OF FILE NUMBER
Henry, William D. 21-13-0452
This schetlule must be campleletl entl filetl if�he answer�o any of quaslions 1 thrwgh 4 on��e reveree sitle ot�he REV-t500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %oF oECO�s E%CWSION TAXABLE
NUMBER THEDTENOFTR�ANSFERSATfACNTACOYEOFTHEDEED�ORREALEBTATE. VAWEOFASSET �NTEREST (�FAPPLICABLE) VALUE
1 Members 1st FCU IRA Certificate of Deposit-Account 20,052.26 1D0.000% o.o0 20.052.26
No. XXX769-17
�See attached statement)
TOTAL(Also enter on Line 7, Recapitulation) 20,052.26
Qf more space is needed,atltlitional pages of the same size)
Copyright(c)2002 torm software only The Lackner Group,Ina Form PA-1500 Schedule G(Rev.6-98)
REV-7761EX+�iD-06)
SCHEDULE H
COMM�ERITANCE�TFAXRNETUVRNAN�A FUNERAL EXPENSES &
RESIDENTOECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Henry, William D. 21-13-0452
Debts of decedent must be reported on Scheduie I.
ITEM DESCRIPTION AMOUNT
q, FUNERAL EXPENSES:
�
s
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
Ciry State _ Zio
Year(s1 Commission oaid
2, a,nornev s Fees Griffie &Associates, P.C. 7,000.00
3. Family Ezemption: (If decedent's address is not the same as claimanPs,attach explanation)
Claimant
Street Address
City State Zio
Relationshic of Claimant to Decedent
4. Probate Fees 588.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 19,247.11
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 26,835.61
Copyright(c)2D09 torm sofiware only The Lackner Group, Inc. Fortn PA-�500 Schedule H(Rev. 10-D6)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Henry, William D. 21-13-0452
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 MetEd (Utilities) 377.44
2 The Sentinel (Advertising) 168.30
3 UGI Utilities 272.77
4 Bender's Hauling (tresh removal) 400.00
5 Cumberland Law Journal(Advertising) 75.00
6 Advanced Disposal Services-(Trash removal) 41.28
7 Travelers(Homeowner's Ins.) 244.00
8 Auction Costs and Fees-(See attached statement) 1,593.22
9 Real=Estate Sale Costs- 14,42A78
Commission $10,380.00
Title Service Fee 10.00
Transfer Tax 1,730.00
ScnoolTaxes 1,695.66
Home Inspection 551.93
Final WaterlSewer 57.19
(See attached HUD-1 Settlement Statement)
10 South Middleton Township Municipal Authority 242.62
1i Orrstown Bank(Bank fees) 1775
12 CPI Mechanical Contractors 139.95
13 Tax Preparer Fee-(2013 Personal Income Tax Return) 250.00
Copyright(ci 2002 form software only The Lackner Group, Ina Fortn PA-1500 Schedule H(Rev.6-98)
_ .
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Henry, Wiliiam D. 21-13-0452
ITEM
NUMBER DESCRIPTION AMOUNT
14 Reserves 1.000.00
H-B7 19,247.11
Copyright(c)2002 form software only The Lackner Group,Ina Fortn PA-1500 Schetlule H(Rev.6-98)
Rev-0St2 E%*(12-00)
scHe�u�e �
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTX OFPENNSYU'PNIA
INHERITANCE TAX RETURN
RESIOENTOECE�ENT
ESTATE OF FILE NUMBER
Henry, William D. 21-13-0452
Repan tlebts Incurted by tha tlxatlant pnor to tlaeth tha�remalnetl unpeld at Ihe date ot tleath,inclutling unmimbvreetl metlicel axpeneea.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 CenturyLink 87.01
2 Med-Ed 115.22
3 Medoptions of PA 2•72
4 UGI Utilities 107.92
5 Real Estate Tax Payments(Cairns,Tax Collector) 501.52
6 South Middleton Township Water and Sewer 121.31
7 Medoptions of PA Z•7z
8 Carlisle Regional Medical Center 272.57
9 CenturyLink 87.01
TOTAL(Also enter on Line 10, Recapitulation) 1,298.00
Qf more space is neetletl,atlditional pages of ihe same size)
Copyright(c)2009 form soitware only The Lackner Group, Ina Fortn PA-1500 Schedule I (Rev. 12-OB)
HEV-051]EX�(t�-0B)
SCHEDULE J
COMINO��nA��Eo������,VAN1A BENEFICIARIES
ID DEC DEN
ESTATE OF FILE NUMBER
Hen , William D. 21-13-0452
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Wortls) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distnbutwns,and transfers
under Sec.9116 a 12
1 Fairlyn C. Henry Wife Joint Accounts 1,327.39
Claremont Nursing & Rehab. Center
1000 Claremont Road
Carlisle, PA 17013
2 Caroi L. Henry Daughter One-third of 162,897.42
130 Dorwood Drive distributable
Carlisle, PA 77013 estate
3 Carol L. Henry Daughter One-third of IRA 6,684.09
130 Dorwood Drive Proceeds
Carlisie, PA 17013
4 Gregory W. Henry Son One-third of 162,891.42
7 Spring View Street distributable
Carlisle, PA �17013 estate
5 Gregory W. Henry Son One-third of IRA 6,684.09
7 Spring View Street proceeds
Carlisle, PA 17013
See continuation schedule attached Continuation 169,575.50
Total 510,053.91
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 wver sheet as a m riate.
� NONTAXABlEDISTRIBUTIONS: �
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2009 form software only The Lackner Group, Ina Fortn PA-1500 Schedule J (Rev. 11-OB)
SCHEDULEJ
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
William D. Henry 04/06I2013 209-12-8599
item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Jeffrey E. Henry Son One-third of 162,891.42
281 Sma�l Valley Road distributable estate
Halifax, PA 77032
7 Jeffrey E. Henry Son One-third of IRA 6,684.08
281 Small Valley Road proceeds
Halifax, PA 77032
TOtel 1fi9.575.50
1
LAST �YYILL AND TE��'AMrZN'N7'
OF
WILLIAM D. HENRY
I, WILLIAM D. HENRY, of 822 Forge Road, Carlisle, Cumberland CoLmty,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and Testament, hereby revoking and making
void al] previous Wills and Codicils heretofore made by me.
FIRST
I order and direct my Executor hereinafter named to pay all of my just debts, �
funeral expenses and expenses involved or connected with the administration of my estate
as soon after my death as is reasonably possible. I direct my Executor to pay all
inheritance, estate, succession and legacy taxes, to which my estate or the transfer of'any �
property hereunder may be subject, and to charge such taxes as pazt of the expenses of the
administration of my estate, being deducted and paid from the residue of my estate and
not to be deducted in any manner from any specific bequests made herein. Howevex, my
Executor need not accelerate and pay those unmatured obligations which, in his, her or its
opinion, it might be proper and more advantageous to retain or renew and pay as they
GRIFFIE&ASSOCIATE,S
Attorneys At Law
2001V. Hanover Szreet I00 Lincoln N�ay East, Suite D
Carlisle, PA 770I3 Page 1 of 10 Chambersburg, PA I720I
become due and payable. If I do not own a burial plot ar a grave marker at the time of my
death, I author.ize my ExecutorBxecutrix, in his, her or its sole discretion, to purchase a
buria] plot and to erect a suitable grave marker at my grave, and to expend sums from my
estate for this purpose.
SECOND
I give, devise and bequeath the rest, reside and remainder of my estate together
with all insurance proceeds thereon of whatsoever nature and wheresoever situate in
equa] shazes io my children, CAROL L. HENRY, GREGORY W. HENRY and
JEFFREY E. H�NRY, who survive me by sixty (60) days, per stirpes. I direct. my
Executor/Executrix to divide among such beneficiaries all personal property nf a
sentimental or family nature (excluding cash, stocks, bonds and the like), including, but
not limited to jewelry, household goods, antiques, furniture and memorabilia, in �
accordance with a separate memorandum which I may place with my Will or deposit with
rny attorney. In the absence of such disposition by memorandum, I direct that the said
tangible personal property be divided between my residual beneficiaries with due regazd
for their personal preferences in as nearly equal shares as practical, with the value of such
dispositions being credited to the share of each respective recipient. If the said
beneficiaries do not agree to the division of the personal property provided for hereunder,
the decision of my ExecutorBxecutrix, including the decision to sell the property at
GffiFFIE&ASSOCIATES
Attorneys At Law
200 AC Hanover Street 100 Lincoln Wa��Easf, Suite D
Carlisle,PA 17013 Page 2 of 10 Chambersburg, PA 17201
public or priva.te sale and distribute the proceeds therefrom as provided hereinafter, shall
be final and conclusive on a11 parties.
THIRD
Any devise or distribution under this Last Will and Testament which is payable to
any beneficiar}�who may be under twenty-one (21) years of age or, in the judgment of my
Executor/Executrix, mentally disabled, shall be held in a separate trust by my
Executor/Executrix as trustee until such beneficiary reaches twenty-one (21) years of age •
or during such period of disability. During the term of any trust created pursuant to this '
Paragraph, the Trustee is authorized to expend and apply so much of the net income and
principal of each such trust as the Trustee shall consider advisable far the health, �
maintenance, support, and education (including college education, undergraduate and
graduate) of each sucb beneficiary until he or she attains twenty-one (21) years of age, or �
until all such amounts aze paid out of trust. I direct that no Trustee shall be required to
give or post band for the faithful performance of the Trustee's duties in this or any other
jurisdiction.
FOURTH
I grant my Executor/Executrix the following powers in addition to and not in
limitation of such powers as my Executor/Executrix shall hold by law:
(a) T'o retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanoner Street I DO Lincoln Wa��East, Suite D
Carlisle, PA ]70I3 page 3 of 10 Chambersburg, PA 77201
/
(b) To join in any corporation, partnership, recapitalization, merger,
reorganization or voting trust plan; to delegate authority with respect thereto;
to deposit investments under agreements and pay assessmants; and generally
to F;xercise all rights of investors, including but not limited to, the voting of
shares,
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(d) To �perate any business that I may own at my death. �
(e) To invest any funds of my estate in any stocks, bonds,notes or other securities ��,
��,
or property, real or personal, without regazd to the principle of diversification
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my ExecutorlExecutrix the broadest investment
powers possible, providing such investments do not unnecessarily preven? the
prompt settiement of my estate.
(fl To sell or otherwise dispose of any properiy, real or personal, tangible or
intangible, at any time forming a pazt of my estate in any manner and on such
terms and conditions as my ExecutorBxecutrix shall see fit in his, her or its
absolute discretion.
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Streef I00 Lincoln Way East, Suite D
Carlisle, PA UOI3 page 4 of 10 Chambersburg, PA I720I
(g) To borrow money for the payment of taxes oi for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
(h) "Co compromise claims without court approval including, but not limited to,
an}� controversies with the United States of America or the Commonwealth of
Peimsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of m}� estate.
(j) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt management of
the settlement of my estate. �
(k) To disclaim any benefits to which I may have bean entitled posthutnously, �
whether said benefits result from distribution from an estate, trust or any other �
such account.
(1) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
'I'estament.
GRIFFIE&ASSOCIATES
Attorneys Af Larn
200 n'. Hanover Street 100 Lincoln Wa��East, Suite D
Carlisle, PA I70I3' page 5 of 10 Chambersburg,PA I7201
FIFTH
No interest of any beneficiary of my estate, either in income or in principal, shall
be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall
any beneficia.ry have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor/Executrix for the liability of such
beneficiary.
SIXTH '
I nominate, constitute and appoint my son, GREGORY W. H�NRY, as Executor
of tlus my Last Will and Testament. In the event my son, Gregory W. Henry, is deceased, �
unable or unwilling to serve or sha11 cease to serve for any reason whatsoever, then I ��
nominate, constitute and appoint my daughter, CAROL L.FIENRY, as Executrix of this �
my Last Will and Testament. In the event my daughter, Carol L. Henry, is deceased,
unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I
nominate, constitute and appoint my son, JEFFR�Y E. HENRY, as Executor of this my
Last Will and Testament. I direct that my Executor/Executrix shall not be required to
give or post bond for the faithful performance of his, her or its duties in this or any other
jurisdiction.
GRIFFIE d ASSOCIATES
Aftorneys At Law
200 N. Hanorer Street I00 Lincoln N'a��East, Suite D
Carlisle, PA 770I3 page 6 of 10 Chambersburg, PA 1720I
SEVENTA
I hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Crriffie R Associates, of Carlisle, Pennsylvania, for legal advice: and
assistance regazding this my last Will and Testament, they having considerable
knowledge of my affairs, views and wishes respecting any matters that may arise at the
probate of this instrument, the administration of my estate, and the execution of the
powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and sea( to this, my Last
Will and Testament, consisting of nine (9) typewritten pages, the first six (6) af which
bear my signature on the side margin, far purpose of idenfification, this o�f �_
day of' !� _,2012.
WITNESS•
°�G'���� —
WILLIAM D.HE
��q., � l� 'i�c rv� n,. -c9 od�s
G.RIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover•Street I00 Lincaln N'a��East, Suite D
Carlisle,PA 1�O13 page 7 of 10 Chambersburg, PA I720I
ACHIVOWL�DGMENT
COMMONWFALTH OF PENNSYLVANIA:
: SS.
COUNTY OF CUMBERLAND .
I, WILLIAM D. HENRY, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge ihat I signed and executed the instrument 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.
� ,P,�n� —
WILLIAM D. HENRY
Sworn or affirmed and acknowledged before me by the Testator this �� �
day of��.u.P_ , 2012.
�?�� �.��s� �— _
NOTAFIAL9EA� public
ROBIN J.BASSEiT�Noiary
GARGommBasia�6�Ires ppBER Zp D C0.
GRIFFIE&ASSOCIATES
Aitorneys At Law
200 A?Hanover Stren.t 100 Lincoln Wa��East, Suite D
Carlisle,PA I7013 Page 8 of 10 Chambersburg, PA I720I
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COUNTY OF CUMBERLAND .
WE, �rc�)� L. �r `�� �d`-�l rin�.e l�y1k�tr�a t�- v �n ,T >
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and
execute the instrument as his Last Will and Testament; that he signed willingly and that
he executed it as his free and voluntazy act for the purposes therein expressed; that each
subscribing w:itness in the hearing and sight of the Testator signed the Last Will and
Testament as �vitnesses and that to the best of our knowledge the Testator was at the time
18 or mare years of age, of sound mind and under no constraint or undue infiuence.
N-/A r�,.n�� �J-Lnl�o n '� m�r-�.11�
5worn or affirmed and subscribed before me by_�(-[N � Cn'�_
_ Q
and� n,vt[,�1���T--�el?��s ��e � day of ,2012.
NOTARIAL SEAL 1��-+'�^" 1(���5���
ROBIhI u.B�SS��N�ry Public Notary Public
_ CARCo m s�s o�n EQplres ppBER�N b C0.
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street I00 Lincoln A�a��Easl, Suite D
Carlisle, PA I7013 page 9 of 10 Chambersburg, PA I720I
qQy,P.�M�NTO�,yDGN OMB Approval No.2502-0265
y x HUD-1
' * * �' A. Settlement Statem��t (HUD-1)
�
� w�'
�
PBqN p�g�� Page 1 of 3
B.�Type of Loan
1.�FHA 2.❑RHS 3,❑Gonv.Unln°. 6.flle NumGer: 7.Luan Numbec 8, Mortge9e lnsurance Case Nuniber:
9.❑.VP 5.�Conv. Ins. 401302261-CB 6800720651
].NOTE; This fartn is fumished Co 91ve you a sCatement of ectual settlement msts.Amoun[s pald to antl Oy the settlement agent ere shown.
Items merked"(p.o.c.)"were paltl outsWe the closing;they are shown here for Informetlonal pwposes antl are not inclutletl In the
mtals.
�.ryame and Atltlrnss of Borrower E.Neme and Atltlreas of Seller � F.Name sntl AtlErc�s of Lender
'ATRICIA A.ZAWATSKI AND KENNEfH L GREGORV W.MENRY,EXECUTOR OF ESTATE MEMBERS 15T FCU
20CKEY . . OF W1lllFM D.HENRY 5000 LOUISE DRIVE,
'.O.BOX 667 622FOHGE ROAD MECHANIGSBURG,VN 17055
=ARUSIE,PA 17013 � CARLISLE,VA 17015
�:Property Location �H.9ettlement qpent
SECU0.ED LANO TRANSFERS,LLC
322 FORGE ROAD, q85 ST,70HN5 CHVRCH 0.0AD,
:ARLLSLE,PA 11015 SHIREMANSTOWN,PA 1]011
�hone:(7ll)901-9342
:OUNTY:CUMBERL4ND
>qRCEL ID:40-24-0]60-026 Plaro.af SetUemant I.Settlemeni Date OB/12/2D13
fOWNSHIP:SOUTH MIDDLETON TOWNSHIP 1068 HARRISBURG PIKE DlabunemeM Cate OB/12/2013
CARLISL�E,PA .
]. Summa of�BOrrower's Transaetion �K. 9nmma of�Seller's Transaction
..____. _ _._ . ._..
100.arbas Amount Due from Borrower 400.Orws AmounY Due to 9e11<r
101. Concrac[Sales Price 5173,000.00 401, G.on[rec[Sales Ptice g173 000.00
302. Versonal Pro e 402. Rersonal Pro e
103.�Set[lemen[clm es to bortower line 1400 5 78511 403. '
109. 4D9,
305. 405. :
Atl'uatmentTOr ttems itl b seller in ativantt Atl uYtmenttor Items altl b �eller fn ativ�nce
106. Q ownTezes 4U6. 31 ownTaxrs
10]. Coun Tezes 501J5 r 8/12R013 W 1/SR014 195.20 407. fiu0 Tazes 501.75 r 8/12/2013 tn 1/1 2014 195.2D
1U8. Assecsmmts 4U8. Mssessments
109. Sctwol Taxes 1695.6600/ r OB/32/13[0 07/03/14 1 500.54 409. School Taxes 1695.fi600/ r OB/12 13 to.07 01/14 1,500.54
iio. aia
iu. au.
iTZ. asz.
120.Gro�YAmount Due fr.om Borrower � 180 480.85 42U.� ross.Amount Due to Spper 1�4,695.74
200.Amou�[s Raid,¢y or in Behalf afBOrrower 5D0.RetluRionc•Im�mamrt Durto�5ellar
flOY..Dapnllbad�eMH�edmanaY.. .. . .�.,.......... ... 2000iUD� �6'06:+5zanvs+De osi[s ,^,.-..... ..n..>,�..: ,...
202. Pnnci at Loan Amoun[from MemEers 1scFN 369 350.00 502.5ettlement Cha es to�5eller ;14 424.76
203. Existinq loan�s)takm subiect to 503. Ezistin 'loan s tnken sub'ect to
204. Aoo��sei Fee Creei[VOC B 425.00 504. -
205. 505.
206. 506. '
207. 507.
208. SOB.
209. SD9.::
AdjustmeMsfor IteTS unPeld by�eller A uc[mmts faNtems un altl b sellar
210.'C1ty/7awnTaxes SSO,+L� ownTaxes
211. CounKTaxes 511..Coun Taxes
212, Assessmen[s 512.WsseSSmenGs
213. 513.
214. 514. ' � -
215. 515.
216. Slfi. �.
21Z 517.
218. 518.
219. 519.
220.Toinl Paid b /for Borrower 366 775.00 520.Totel Retluctlon Amount Dua 6alle� 14�424.�8
300.Caeh at Sattlamanc from/ro Borrower 600.Caeh et SatLement to/trom'eellar
301. Gmss emount Gue from bortower(I�ne 120) 180,480.85 601. bmss emounLtlue to'seller IIne420� �� . SSn4,695.�4
302. Less amoun[s oaid bylfor bortower(Ifne 2207 166,]75.00 802.Less reEUCklons In imount tltreseller Ilne 32D' � YR 424.78
303.Cash X From To Bortower' .F13,]Ob.85 6�3.Gash X To 'PCOm�Seller� �"p,� 160,2�0.96
The Public RepoNng BuNen fo�ihla colbdion ollnimmelion is eelmated et 35 minules per response�or colkctinB�reWewjnO�antl repoNrig Me tlaU.T�IS apency mey nol
mNect N�s.lnlartnetion,entl you ere rwl requlretl lo mmplele Ihis fomi,unless II tliapeys a wrtenlly velid OMB eonlrol numtien No confi0antiellry is essuretl;IDls tlisGosure
Is men0etory.TM1IS is oasignotl�o pmWGe Ue petliec.lo e RESPA covere0 Veneeclion wlih'Informe�ion OutlnB��e eeWament prames.
Initials ��
�G�
901302281-CB HUD-1 Page 2 0(3
�h. Settlement Charges � � �"'
100.Totel Real Eetete B�oker Fees;30575.00 paitl From Paitl From
Dlvislon af Commission Ilne 700 as follows:
701. 5190.00 M Haoke Hooke antl E[kman eorrower's Funtls .eeUer's Funtls
702. 53B5.OD M ERA-NRT LLC 5 190+ 195 FC Se[tlemen[ A[SeMement
703. Commisslon alA at settlement q195.00 10 380.00
709.
800.Itamc'Pay�ble in Connec[fon wikh Lonn �
801. Our o lnation Cha e 955.00 from GFE#1`
802. Your credlt ar cha e oints for the s ecific inrerest mte chosen from GFE R2`.
803. Your ad'us[ed od Inatlon c�a es � � fiom GFE A q55AU
809, A ralsal Fee co Membere 1st FCU fmm GPE#3� 425A�
8U5, Credl[re ort from GFE#3
806.Tax Servlce fmm GFE#3
807. Flootl Cert.Fee from�BFE#3 �
BOB.
900.Itams Raqufretl by LanOer to Ba Paltl fn Ativence
9U1. �aily fnteres[charqes from 8/12/2013 to 9/1/2013�20.2623/tlay (��om GFE N30) ;405.25
Members 15[fCU �
902. Mo a e Insu2nce Premlum from GFE N3
903. HomeowneYS insuance POC 440.00 irom GfE A31
904.
1000.Re�ervec Dppositatl-wit�Lentlar
1001.Initlal Ge oslt for our esvow acmunt from GFE x9 671.86
1002.qazard ins.Reserve 2 MonM s�@ 36.6] r MonM s Members ls[FCU 73.34
1003.COUnt Pro e 78%es7.Month 5:@ A5.99. er.Month 5 Members,lst FCU 321.93
1009.SChou Tezes 3 Month s@ 14131 er Month s Members lst FCU 4423.93
1005. re a[e Httountin �AE-ustment to Members ls[FCU -$147.34
1006.
3007.
iioo.rm�cn.ryec- '
l101.Title servias aM lender's H[le Insumnce to Semred lnntl Trensfers LLC tmm GFE u4 ;1 695.00 p10.00
1102.SettlemGn[Or ClOSf fee tu Secure0 lnn7 TrensFers LLC 225.00 �
1303.Owner's citle Insumnm to Sewrea lantl Tmnsfers LLC (fmm GFE 4'S 0.00
1104.Lentler's tlde insumnre ro Secured Lantl Transfers LLC 1 375.00
1105.1.enGer's tltle o0 Ilmlt . 164 350.Oo
1106.Owner's[Itle oli Ilmit 173 000.00
3107.A9enPs poNon of the total tltle insu2nce premwm ro Securetl Lantl ;1,273.50
Trensfers LLC
1108.UnGerwtlteYS ortlon oF the total[Itle Insurance remium ro iRGGSaIe 141.50
1309Ansumtl�Elasin Pmtec[ionLetterro-TRGC � 75,00
2o0.aover'ImenARacaMlpy�lnd;Tnnsfar Ghargas �
Y201BdGt� elirecro1931 '...Hd CS .. ...:... .:._.,�..• . _' .. -�fromaPGM'^P:-. . ....a� 'gg{pp�., ._.a:::., .�....
1202.Deetl 6].00 Mort a e Z1 Pa es 101.00 Releases
1203.Transfertnxes from GFE i8 1,730.00
3209.0 /COUn mx/scnm s Deetl ll30.00 Mort a e
1205.SmCefnx/sWm s Dretl$1730.00 Mort a e 1]30.00
1206.
1300.Atltlltionaf fiettlamanT Cberges
1301. uiretl servlces[ha[ oo an s�o for fmm GFE Y6
13W.2013/14 Sc�oolAeal EslaCe Taxrs ro RobM C Caims Taz Collecror 1 69566
1303.2019�COUn /Tw :-Taxes'tu-'RObert-C.CaIms�Taz-COlkc[or �$551:93
1304.Home Ire c[ion to MltlPenn Rome lns eRion POC B 340.00
1305.Flnal WeteySewer BIII ro SMTMN 5719
1400.TOtal Settlement Cherges(enter on Iines 1�3,Section�antl 602,Section K) 55,785.11 f14,424.78
11 you neve any queatwns eEON ihe wllbmanl cherpas and loen�arms IiakE on Nis�omi,please mnlecl you�kntler.Seltlement egen!u iwt�eaponslble lor contenl ol
lunoefs asaeameMS on HII�.
l�e aellafs entl Eartowe�c slpnelures Mreon ecknavhOge Neir epprovel entl sgMry iMtr uMerslentll�Ihel lex anJ Insmance pmrzBOns an0 rexrves ere�eeetl on
fiBUres kr iM precetll�g yae�o�cuppNetl by olhers o�es�imabtl�at Il�e u�rta�l yeer,eiM in Ne evenl o�eny Manpe fot Ne cuirenl ynct,ell reaecsery atll�sbneNS wY�M
ma0e OaMean Lortowe�en0 ealle�Oietlly.Any tlefiG�aeNnquenl Was ar mwqeBe peyolls wlll Ee pmmp�ty�eimbwsetl to Ne aeNemant eBan�Gy Itie ae�le�.
I�ave urelulry reNeweE tl�e HUDt Seltlemen�Sletamenl erq b Ipa Lecl o�my MnaWeOpe entl pelle6l�Is tma aM eccurete sla�emenl of all remipls eiM Gu�uraem¢n�s
metle on my e�sounl or Ey me in Nls Vencedlon.1 NN�er caN(y Nel 1 M1eve remiwtl a cOpy of Ilie HU0.1 Setllemenl S�elemenl.
NUYERS � 9ELLERS ���
Estete o Illam�.
Fe1�IGaA Zawelaki /'
�� d-� 8y:Gre ry W. enry, or
M.anneN L.Rockey
T�e HUD-0 Setllamenl 5�e�ement whle�I heve O�ePeretl is a true erM emumle eccounl oi Nis Venaection.I�ave rauee0 or� nube Ne IUMS�0�e�ISGURBtl in
BLCOf�dI1fG W�111II1156�BIBTB111.
EettlementABen� Oate
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*Any 1[ems marketl"VOC"were palJ ou[sitle qosin9 Dy: Borrower FOC(B),LenOer POC(L),Mortgage Bmker POC(MJ,Seller POC(5),Real Es[ate
h9ent VOC(R),or O[her POC(0).
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� R���'S �UCTION SERVICE «H 79L,
. e '3b95-�i�r►er H�ighway , -Carlisle,PA"1=7A;1;5,— .
Bill Row�`-(AU,'1538L) "" " Dave Rowe (AU 2295L)
249-1978 215-1044 574-1008
Auction Is Action Call `�R:owe" For S¢tisfaction
, ,,.-.-. J�'
SELLERS NANPE�! I �+4,�. �. NiE A312.�Y DATE v+�� � �i„ ti.o �'a,
ADDRESS _ � v ��4.'�AA �-. ��,� l` S'?mu��..a.a- PHONE �r o — ��". !m -1 lA
OTHER _ AUCTIONEER % �_
AUCTION DATElLOCATION �+z+.++��. — � �R6i- CLERK % -
DESCKIPTION OF MERGHANDISE �`"'"`""' � �
r�.1 � "�u�l"+i+o� �we.- � m
C'�L.t'a�z ��3� ( �f�.4+t S --?t� c_S. �' (�,�n/� 4 — /d,.R--c.c ^r'�'k,fi 1/5
'.�/l�.c..d]Xi�f.+�lfi ^.� �.�.. R w C..A�Id ��/Sai\...
. +S � . �.a�w. Rs i �- �t.. � l�� TT'11n.,U+
lg° aa�.� °L �� !3 S L�..+ �✓4- C WA-�n- �.. m er�,e3 'S:Md� , tsn,_��n.�.�.+�
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�,t�i&�'-F �n-.n, ^rw..�.c�..� . z�.� _ c....�,n.�c.c,,.� .'!. � � _
I Commission the Auctioneers to eell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & ou d as nec ss ' ' ' t ' d�pceesn-
� �y are"fias �
. _. .
, . e
, i y or providing merchantahle title and for delivery of
� ' ,.• a'ses. I agr� to hold harmless the Auctioneers against any claims of t nature referred to in
this agreement. �
�..�-- .-�-- �
AUC`PION SIGNA'1'URE SELLER3 SIGNA
Total �ales (Clerking Tickets Attached) $ � � �^ �+ S�
� Less Sale Expense:
,,. -�. �
4 �; °/a Commisaion Auctioneer $�S`°f ''>
% Commission Clerks $
� 4V
OTHER: fJ-.A.a. L...�v�- ''� o —'
y�
_ S D t�++-� �.��- 9�+
TOTAL SALE EXPF:NSE DEDUCTED � / � -�" � �'�
.a-8
SELLERS NET � � '�°� � `
f
` Asset Disposal-Estate of William Henry
6ate Sold Item Value
�
5/10/2013 Dlning Room Set 374.00
5/10/2013 Trinket9 0.50
5/10/2013 Pliers 1.00
5/10/2013 + Taols 20.00
5/10/2013 Garden Equi . 11.50
5/10/2013 Do Gge 2.0�
5 10/2013 Pans 1.00
5/10/2013 Gun Gbinet 30.00
S/10/2013 Tools 1�.00
S/SO/2013 Garden Equip. 40.00
5/SO/2013 Fan 5.00
5/10/2013 Tens Unit 20.00
5/d0/2013 Tools 43�UD
5/10/2013 Sewin Kit 2.00
5/10/2013 6revy Boat 2.OD
5/10/2613 Painterushes 2.00
5/10/2013 Hamper 2.00
5/10/2013 BoWls 3.00 ,.q�
5/10/2013 PaintBrushes� 2.00
5/30/2013 China 25.00
5/10/2013 Fan end GUn Cese 5.00
5/10/2013 CD's 3.00
S/10/2013 Hnse 5.00
5 10/2013 lawn Ed er 30.00
5/10/2013 Gol(Shnes/Balls 20.00
5/30/2013 Toaster 5.00
� 5/10/2013 Toals 15.00
r
5/10/2013 Cen[erpiece 1•OD
5/10/2013 Massager 5.00
5/10/2013 BeerMelster _ 5.00
5/10 2013 Sand a er 4.00
5/10/2013 Trinkets 4.50
5/10/2D13 Brassirays 2.00
5/30/2013 Tools 6.�
5/10/2013 Boots/Spreader 30.00
5/li/2013 Tools 19.50
5/31/2013 Urns 7.50
5/11/2013 Candles 3.00
5/11/2013 Knicknacks 1.00
5/11/2013 Taols Z•�
5/11/2013 XmasStand 5.00
5/11/2013 Saw and Level 10.0�
5/ii/2013 Golf Balls 3•�
5/11/2013 Ven Refills 3.00
5/11/2013 Pressure Cooker 10.00
5/11/2013 Ta61e Saw SU.00
5/1&/�od3 @ox of Nails/SOraws 7,00
5/31/2013 Box of Nails/Screws 15.00
5 11/2013 Cru[ches _ 3.00
5/11/2013 Snow Blower 100,00
5/11/2013 Xmas Wreath 2.00
5/11/2013 Scale 10.00
5/11/2013 End Ta61es/lam s 150.00
5/11/2013 Air Purifier 45.00
5/il/2013 7ools 4.50
5/16/2013 Mattress/Baxsprings 20D.U0
Total 1,367.00
.
•Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 04/2013
Totai Price Total Value Totai Interest YTD Interest
25.00 $74.04 $49.04 $1.44
Bonds: 1-1 of 1
Issue Next Final Issue Interest
Serial # Series Denom Date Accrual Maturity Price Interest Rate Value Note
L482389801EE, EE , $50 10/1991 ,10[2013 10/2021 $25.00 $49.04 4.00% $74.04
Totalsforl Bonds $25.00 $49.04 74.04
N otes
NI !Not Issued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earnin interest
http://www.treasurydirect.gov/BC/SBCPrice 5/30/2013
St
�
MEMBERS 1"�
PHDHRALCRHDlT IIIaION
PRIMARY.OWNER Wiliiam D Henry
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 320769-00
Date Account Estabiished 01/03/20D8
Principal Balance at Date of Death $36,77
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $36.77
Name of Joint Owner Fairlyn C Henry
Date Joint Added 01/03/2008
IRA CERTIFICATE OF DEPOSIT:
Account Number/Suffix 320769-17*
Date Account Established 02/14/2012
Principal Balance at Date of Death $20,048.16
Accrued Interest to Date of Deatlr' $4.10
Totai Principal and Accrued Interest $20,052.26
Name of Beneficiaries Jeffrey Henry Carol Henry Gregory Henry
'Rollover from IRA CD 320769-16 opened 11/08/2010
PRIMARY OWNER: Fairlyn C Henry
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 353770-00
Date Account Estabiished 04/08/2009
PrinciPal Balance-et'Date ofDeath $1.5,00
Accrued Interest to Qate of Death $D:DO
Total Principal and Accrued Interest $15.OD
Name of Joint Owner Wiliiam D Henry
Date Joint Added 04/DB/2D09
IRA CERTIFICATE OF DEPOSIT:
Account NumbedSuffix 353'770-77'*
Date Account Established 02/14/2012
Principal Balance at Date of Death $25,432.11
Accrued Interest to Date of Death $4.01
Total Principal and Ar,crued Interest $25,436.12
Name of Beneficiary William D Men .ry
`*Rollover from IRA CD 353770-16 opened 11/08/2010
MEMBERS 1� FEDERAL CREDIT UNION
Tessa L Klug�hY%'3�
Lending Insurance Support Specialist
April 29, 2013
Estate of: WILLIAM D HENRY
Date of Death: 0410 6/2 0 1 3
Social Security Number: 2D9-12-8599