The URL can be used to link to this page

Home My WebLink About04-28-15 pennsy(vania 1505614105 WPMTMM OF REVEME EX(03.14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, RA 17128-0601 RESIDENT DECEDENT I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY j08052012 04171916 Decedent's Last Name Suffix Decedent's First NameMI Headley f Conrad E] (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI G Headley Caroline �] THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (31D 1.Original Return c=D 2.Supplemental Return C=) 3. Remainder Return(date of death prior to 12-13-82) ri 4.Agriculture Exemption(date of cm 5.Future Interest Compromise(date of C=:) 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) CND 7. Decedent Died Testate C=) B. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) C=:> 10. Litigation Proceeds Received C=) 11.Non-Probate Transferee Return C=:> 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) 13. Business Assets (31D 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Taylor P Andrews, Esq i(11 t) 243-0123 First Line of Address _ _ _ 178 W Pomfret Street _.__-_�.__'.- ---___._..- __._ _.__�._.. --____.__ Second Line of Address I City or Post Office State ZIP Code Carlisle PA I 17F3 Correspondent's email address: REGISTER OF WILLS USE ONLY ��REGISTER OF WILLS USE ONLY wr ��17 6XfjF FILED Wrip- M C> 71 C'�p DATEXILED STAMP __j = I.f CO co C:) PLEASE USE ORIGINAL FORM ONLY Side I `_I fr J C:� 5056141 5 1505614105 • 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedents Name: Conrad E. Headley RECAPITULATION 1. Real Estate(Schedule A). ....... ............................. .... .... 1. r 0.00 2. Stocks and Bonds(Schedule B) ........ .......... ........... .... ...... 2. i 5,867.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. L v 0.00 4. Mortgages and Notes Receivable Schedule D 4. I 0.00 1 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. l- 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. ..... 6. I� 74,619.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property f 0.00 (Schedule G) O Separate Billing Requested... . .... 7. F 8. Total Gross Assets total Lines 1 through 7 . .... ........ 8. 80,486.00 9. Funeral Expenses and Administrative Costs Schedule H 9. j 0.00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).... .. ... ..... . 10. 0.00 11. Total Deductions(total Lines 9 and 10). .......... ..... .... ..... ........ 11. 0.00 12. Net Value of Estate(Line 8 minus Line 11) . ............. ..... ........... 12. 80,486.00 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) 13. 0.00 ........................ I 14. Net Value Subject to Tax(Line 12 minus Line 13) ............. 14. 80,486.00 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.0 0 80,486.00 15. 0.00 16. Amount of Line 14 taxable " at lineal rate X.0_ 0.00 16. 0.00 17. Amount of Line 14 taxable 0.00 at sibling rate X.12 i 0.00 17, 18. Amount of Line 14 taxable 1 at collateral rate X.15 0.00 18 0.00 19. TAX DUE .............. .... ............ ....................... .... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIG TURE OF PERSON RESBO SIBL F ILING E RN DATE rl/ ADMESS 28 Elm a CV cle, N wville PA 17241 SIG_ P E YERSON RESPONSIBLE FOR FILING THE RETURN ADDR SS I 7•p��5 77 Pomfret St., Carlisle, PA 17013 111111111111111111111111111111111111111 IN Side 2 _l 1505614205 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Conrad E. Headley STREETADDRESS 28 Elm Tree Circle CITY STATE ZIP 17241 Nevvville PA Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 (See instructions.) Total Credits(A+B (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line I +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. 1-7 77-11 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 income of the property transferred...................................................................................... F-1 N b, retain the right to designate who shall use the property transferred or its income ............................................ 171 a c. retain a reversionary interest ............................................................................................................................ 171 0 d. receive the promise for life of either payments,benefits or care?.........................................._........__........... F-1 N 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?..................................................._........................................................ F❑-1 3. Did decedent own an"in trust foe'or payable-upon-death bank account or security at his or her death?.............. 171 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? ....................................................................................................................... E71 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 4_ ' For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net valueoftransfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(11)(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 pare.nt,an adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(I • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. i SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER Headley, Conrad E. 21-12-0943 All property jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 109 shares of Prudential Financial,Inc @$53.82 per share $5,867 TOTAL(also on line 2,Recapitulation) $5,867 SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Conrad E. Headley 21-12-0943 if an asset was made joint within one year of the decedent's death,it must be reported on Schedule G Surviving Joint Tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A.Caroline G.Headley 28 Elm Tree Circle.,Newville,PA 17241 Wife B C Jointly-owned property: ITEM NUMBER LETTER FOR DATE MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF TOTAL VALUE OF DECO'S%INT. DOLLAR VALUE OF DECEDENTS JOINT TENANT JOINT INSTITUTION AND BANK ACCOUNT NUMBER OR ASSET INTEREST SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR JOJNTLY.HELD REAL ESTATE F&M Bank accounts: 1 A 10-Jul-01 checking 0003410560 . $42,389 50% $21,195 2 A 21-Sep-01 money mgt 0007065124 $43,500 50% $21,750 3 A 09-Oct-01 CD 0152968172 $4,554 50% $2,277 4 A 30-Apr-02 CD 0152975029 $5,375 50% $2,688 5 A 05-Apr-06 CD 0152983283 $11,504 50% $5,752 6 A 10-Jun-09 CD 0152994924 $41,916 50% $20,958 TOTAL(also on line 6,Recapitulation) $74,619 SCHEDULE BENEFICIARIES ESTATE OF FILE NUMBER Conrad E. Headley 21-12-0943 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)l I Caroline G.Headley Wife 100% II NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B.Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS(also enter on line 13,Recapitulation) $0 f Fg7A 20 South Main Street TRUST Chh bolo amrnbb ersburg,PA]7201 Last statement:July 10,2012 Page 1 of 4 This statement:August 10,2012 0003410560 Total days in statement period: 31 (7) **************AUTO**3-DIGIT 172 Direct inquiries to: 014921.1665 AT 00.374 6 1 370 717 776-2240 '1411"I�'III"II'd'IIIIII��I'IIIII'll'I"111111411111111'I" F&M Trust CONRAD E HEADLEY 9 West Big Spring Avenue CAROLINE G HEADLEY Newville, PA 17241 28 ELM TREE CIR NEWVILLE PA 17241-9491 WELCOME TO YOUR NEW AND IMPROVED F&M TRUST STATEMENT! SUMMARY OF ACCOUNT BALANCES Account Number Ending Balance Relationship Checking 0003410560 $41,878.04 Money Management Personal 0007065124 $43,510.66 Certificate Of Deposit 0152968172 $4,554.22 Certificate Of Deposit 0152975029 $5,375.03 Certificate Of Deposit 0152983283 $11,504.41 Certificate Of Deposit 0152994924 $41,915.58 Relationship Checking Account number 0003410560 Beginning balance $52,540.24 Enclosures 7 Total additions 4,110.17 Low balance $39,002.97 Total subtractions 14,772.37 Average balance $45,920.02 Ending balance $41,878.04 Avg collected balance $45,920.00 Interest paid year to date $27.38 CHECKS Number Date Amount Number Date Amount 2757 07-11 434.01 2766 * 07-25 12,597.45 2760* 07-25 10.00 2768* 07-25 56.89 2762* 07-20 30.00 2770 * 07-25 250.00 2764* 07-13 49.40 `Skip in check sequence Fg7A20 South Main Street TRUSTPO Bo)� Chamb6010 ersburg,PA 17201 CONRAD E HEADLEY Page 2 of 4 August 10,2012 0003410560 DEBITS Date Description Subtractions 07-12 Electronified Check 17.20 SAYLOR's MARKET PURCHASE 120712 — CITY=NEW\/,ST=PA SER#=2763 26.49 ---23 Electronified Check DIRECTV CHECKPYMT 120723 2765 14.12 6-7-23 Electronified Check FIA CardServices CHECK PYMT 120720 2767 51.71 07-23 Electronified Check SAYLOR's MARKET PURCHASE 120723 CITY=NEWV,ST=PA SER#=2769 86.24 67-27 '—Electronified Check SAYLOR's MARKET PURCHASE 120727 CITY=NEWV,ST=PA SER#=2771 39.67 07-31 ' Preauthorized Wd ConturyLink SPEEDPAY 120731 37.50 08-01 Electronified Check SAYLOR's MARKET PURCHASE 120801 CITY=NEWV,ST=PA SER#=2772 -- 08-01 P -- Preauthorized Wd 159.48 ARC LIFE ADMIN.120801 139.93 6-8-03 ' Preauthorized Wd PPL EU ELEC SVC 120803 472.99 68-06 Pre—authorized Wd United Healthcare PREMIUM 120806 211.28 08-07 Electronified Check BARCLAY CARD US CREDITCARD 120807 2773 88.01 68--10 ' Electronified Check SAYLOR's MARKET PURCHASE 120810 CITY=NEWV,ST=PA SER#=2774 CREDITS Additions Date Description 1,164.27 07-27 Preauthorized Credit RPS-PRINCIPAL PRINCIPAL 120727 88.34 07-31 Preauthorized Credit PHI Gift Annuity PHI 120731 b-8--01 ' Preauthorized.Credit 102.61 ILPF-GCIU PENSION 120801 163.30 08-01 ' Preauthorized Credit BENEFIT PAYMENTS DEPOSIT 120801 Fg7W 20 South Main Street TRUST mb sb 0 Chambersburg,PA 17201 CONRAD E HEADLEY Page 3 of 4 August 10,2012 0003410560 Date Description Additions 08-03 Preauthorized Credit 597.40 US TREASURY 303 XXSOC SEC 120803 08-03 Preauthorized Credit 1,733.40 US TREASURY 303 XXSOC SEC 120803 08-09 Preauthorized Credit 255_.00 SSA TREAS 310 XXSOC SEC 120809 08-10 Interest Credit 5.85 DAILY BALANCES Date Amount Date Amount Date Amount 07-10 52,540.24 07-23 51,917.31 08-03 42,389.47 07-11 52,106.23 07-25 39,002.97 08-06 41,916.48 07-12 52,089.03 07-27 40,081.00 08-07 41,705.20 07-13 52,039.63 07-31 40,129.67 08-09 41,960.20 07-20 52,009.63 08-01 40,198.60 08-10 41,878.04 INTEREST INFORMATION Annual percentage yield earned 0.15% Interest-bearing days 31 Average balance for APY $45,920.02 Interest earned $5.85 OVERDRAFTIRETURN ITEM FEES Total for Total this period year-to-date Total Overdraft Fees $0.00 $0.00 Total Returned Item Fees $0.00 $0.00 Money Management Personal Account number 0007065124 Beginning balance $43,499.57 Low balance $43,499.57 Total additions 11.09 Average balance $43,499.57 Total subtractions 0.00 Avg collected balance $43,499.00 Ending balance $43,510.66 Interest paid year to date $142.15 CREDITS Date Description Additions 08-10 Interest Credit 11.09 FZg7A 20 South Main Street TRUSTChambersburg,bolo ambb ersburg,PA]7201 CONRAD E HEADLEY Page 4 of 4 August 10,2012 0003410560 DAILY BALANCES Date Amount Date Amount Date Amount 07-10 43,499.57 08-10 43,510.66 INTEREST INFORMATION Annual percentage yield earned 0.30% Interest-bearing days 31 Average balance for APY $43,499.57 Interest earned $11.09 OVERDRAFT/RETURN ITEM FEES Total for Total this period year-to-date Total Overdraft Fees $0.00 $0.00 Total Returned Item Fees $0.00 $0.00 Thank you for banking with F&M Trust SCHEDULE BENEFICIARIES ESTATE OF FILE NUMBER Conrad E. Headley 21-12-0943 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTMBUTIONS(include outright spousal distributions,and Lrawrers under Sce.9116(c)(1.2)) Caroline G.Headley Wife 100% II NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B,'Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS(also enter on line 13,Recapitulation) $0 LAST AVILL AND TESTAMENT OF CONRAD E. HEADLEY 1, CONRAD E. HEADLEY, of West Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any and all wills and codicils heretofore made by me. ITEM 1: My personal representative shall pay from the residue of my estate the expenses of my last illness, funeral and burial debts duly allowed against my estate, and all death taxes(Pennsylvania inheritance tax and federal estate tax)occasioned by my death and incurred with respect to all property taxed to my estate regardless of whether such property passes by this Will or passes outside of this Will. ITEM 11: 1 bequeath those my automobiles,personal effects,household goods, and other tangible personal property of like nature (not including cash or securities),together with any existing insurance thereon,if any,as may be my individual property and not the property of my Wife, CAROLINE G. HEADLEY, or owned jointly by me with her, as set forth in a separate memorandum which I shall place with my Will to the persons therein designated. If I shall leave no separate memorandum, or with regard to my automobiles, personal effects, household goods, and other tangible personal property of like nature (not including cash or securities) not referenced by such memorandum, I bequeath such property to my Wife, CAROLINE G. HEADLEY, if she survives me by thirty(3 0)days. Should my Wife,CAROLINE G.HEADLEY,not be living on the thirty-first day after my death, I bequeath such tangible personal property and insurance thereon to my son,CONRAD RICHARD HEADLEY. . I ask,but do not require,that my son,Conrad,shall transfer to my son,RALPH W.HEADLEY,items that Conrad believes RALPH would appreciate having. As the sole recipient of this tangible personal property,my son,Conrad,shall have absolute discretion as to what items should be preserved,what should be discarded,what should be donated, and what should be sold. ITEM III: I devise and bequeath the residue of my estate, of every nature and wherever situate,to my Wife,CAROLINE G.HEADLEY,providing she shall survive me by thirty (3 0) days, ITEM IV: 'Should my Wife,CAROLINE G.HEADLEY,predecease me or die on or before the thirtieth day following my death,I devise and bequeath the residue of my estate,of every nature and wherever situate, as follows: A. I give and bequeath one half(1/2) of the balance of my estate to Delaware CarePlan, Inc., TRUSTEE, IN TRUST, for my son, RALPH W. HEADLEY administered pursuant to the terms and conditions of the supplemental needs trust[not to be confused with any self-settled trust created by my son, Ralph or by his guardian with his assets] executed by me and known as the "Ralph William Headley CarePlan Trust". B. I give and bequeath the balance of my estate to my son, CONRAD RICHARD HEADLEY. If he shall not survive me,I give and bequeath his share to his issue,per stupes. If he shall not survive me and he shall have no issue, I give and bequeath his share to the TRUSTEE referenced above with the share to be added to the Trust defined above for my son, RALPH WILLIAM HEADLEY. ITEM V: No interest of any beneficiary under this Will, any codicil hereto, or any Trust created herein, shall be subject to anticipation or voluntary or involuntary alienation, ITEM VI: My Executor and Trustee, and their successors, shall have the following powers in addition to those vested in them by law, and by other provisions of my Will, applicable to all property, whether income or principal, including property held for minors, exercisable without court approval, and effective until actual distribution of all property: A. To borrow money from any person or institution, including my Executor or Trustee, and to mortgage or pledge any or all real or personal property as my Executor or Trustee in its sole discretion shall choose. B. To compromise any claim or controversy. C. To invest in all forms of property (including stock, common trust funds and mortgage investment funds,whether maintained by my corporate fiduciary or others)without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principal of diversification or risk. D. To retain any or all of the assets of my estate,real or personal,without regard to any principal of diversification or risk. E. To sell at public or private sale,to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as they deem proper. F. To employ agents, brokers, legal counsel, realtors, and other assistants and advisors,investment advisors,and specifically including an experienced and qualified case manager to advise Trustee as to the most appropriate care and services to be provided to Beneficiary as well as the consequence on government benefits of proposed distributions from the trust,as shall be deemed by the Trustee needed for the proper administration of the Trust, and to do so without liability for any neglect,omission,misconduct or defiult of any such agent or representative, provided he, she or they were selected and retained with reasonable care. ITEM VII: I appoint my Wife,CAROLINE G.HEADLEY,Executrix ofthis my Last Will and Testament. Should my Wife fail to qualify or cease to act as Executrix,I appoint my son, CONRADRICHARD HEADLEY of Castle Rock, Colorado, as Executor of my estate. If neither my Wife nor my son qualify or act as Executor,I appoint F&M Trust, Shippensburg,PA,as -Executor of my estate. ITEM VIII: I direct that my Executrix and her successors shall not be required to give bond for the faithful performance of her duties in this or any other jurisdiction, IN WITNESS WHEREOF, 1, CONRAD E. HEADLEY,have hereunto set my hand and seal to this my Last Will and Testament,consisting of six(6)printed pages,each of which bears my signature, this 5th-day of June 2008. 411,9441,l (SEAL) CONRAb'E'AtADLEY_,Testator Signed, sealed, published and declared by the above-named Testator, CONRAD E. HEADLEY,as and for his Last Will and Testament,in the presence of us,who,at his request,in his sight and presence,and in the sight and presence of each other,have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA 9S. COUNTY OF CUMBERLAND WE, CONRAD E. HEADLEY, TAYLOR P. ANDREWS, and C�'41 1�e Testator and witnesses, respectively, whose names are signed to the foregoing or attached instrument,being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as and for his Last Will and Testament and that he signed villffigly�and the,he-executed as his-frec and voluntary act for the purposes therein expressed, and that each,of the witnesses, in the presence and hearing of the Testator,signed the Will as witnesses and that to the best of their knowledge the Testator was at the time eighteen(18) or more years of age, of sound mind and under no constraint or undue influence. CONRAD t.,HEADLEY, Testator W6 AkZews, Witness Wiin6's-s Subscribed,sworn to and acknowledged before me by CONRAD E.HEADLEY,the Testator,and subscribed to and sworn or affirmed to before me by TAYLOR P. ANDREWS and witnesses,this 5'h day of June 2008 COMMONWEALTH OF PENNSYLVANIA -(SEAL) NOTARIAL SEAL Notary Public L SHELLY SEXTON, Notary Public Carlisle Boro, Cumberland County MY Commission Ernirnparz April 26, 20111