Loading...
HomeMy WebLinkAbout01-0440 PETITION FOR PROBATE and GRANT OF LETTERS Estate of JOHN E. HENRY also known as , Deceased. No. To: ;;J.J- 0/- ~'IIJ Register of Wills County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 189 - 09 - 4271 The petition of the undersigned respectfully represents that: Your petitioner, who is 18 years of age or older, is the personal representative named in the last will of the above decedent, dated October 31,2000. Decedent was domiciled at death in SOUTH MIDDLETON TOWNSHIP, Cumberland County, Pennsylvania, with her last family or principal residence at 34 Otto Avenue, Carlisle, Cumberland County, Pennsylvania 17013. Decedent, then 88 years of age, died April 4, 2001, at Sarah Todd Nursing Home, Carlisle, Cumberland County, Pennsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent. Decedent 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: TOTAL $ $ $ $ $ 2,000.00 2,000.00 WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters testamentary thereon. Q~AL.J. (\~1~7" JOSE~iNEJ1HENRY ~ r+ ( 34 Otto Avenue Carlisle, PA 17013 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner above-named swears that the statements in the foregoing petition are true and correct to the best of the knowledge of petitioner and that as personal representative of the above decedent petitioner will well and truly administer the estate according to law. Sworn to and subscribed <::::t-f'./,J ~ ~A 1 , A_ · Q ~ before me this 1,-rl day of Jel;EPHINrIHENRY r . I May 2001. " ~/ L't___ ~ Estate of JOHN E. HENRY, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, May 3rd , 2001, in consideration of the petition attached hereto, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated October 31, 2000, described therein, be admitted to probate and filed of record as the last will of JOHN E. HENRY, Letters Testamentary are hereby granted to JOSEPHINE J. HENRY. Probate, Letters, Etc. Short Certificates (3) Renunciation X-PAGES (2) JCP TOTAL Filed: May 3rd,2001 $ 25.00 $ 9 .00 $ $ 6 .00 . $ 5 . 00 $ 45.00 a~ FEES 717 -243-6090 CALL ATTY IRWIN OFFICE AT 243-6090 HI05805 REV 9/86 This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. I" ,I (f/~"'~'/"/""" III"~ ~\.,\\ OF PE';----__ Ill'~~'" '" "1',"" l~' , ',", C",' , ~\. '~~-' ~;, i=-I ~C' - --.-" c' _ I~~ ~~\,- -~::' .I:i:~ \*~,P "'~' ,>I*f \.~ ','~~.,., ~l "':,,~ ~~III\ ....}?lMEN1 \)\ ~ "" """"""",,/1'1'#/111"" II )t._ <:\. ~tu..&'Q~ Local Registrar Fee for this cerrificate, $2.00 P 7248090 AfR 6 2001 Date 21-2001-440 Hl05.;43 R.... 2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH 'RINT I .HEltT (INI( ,. AGE\Uol_ UNDER 1 YEAR - .,..,. John E. Hen UNOfR I OM Houts ! "'Inu'l.. SEX a. Male !WI: FU NtJM8I:A SOCIAL SECURITY NUMBER .. 189 - 09 DATE OF 0E..Qlf lMonft. OIly. -... .. April 4, 2001 NAME C* DECEDENT (fIr,..~. L_ 8IRTHI'\.ACI! iC., .... s.... QI far.... CounIrVl 88 v... COUNTY OF CERH :="'0 dl . Cumberland _~rlisle DECEDENt.S USUAl OCCUPRlON d~~~::=:r . ULDe rtment Manager .... Shoe CO. DECEDENT'S MAIUHQ ADtll1ESS ISO.... CiIyITown. -. C"CodeI DeCEDENt.S 34 otto Ave. ~~ Carlisle, PA 17013 M~ ,I. FRHER'S NAME (First, Middle. L.Ml') ,I. White MAAeTALSWUS.~ --- -~ Sl.ORVlVI'IG Sl'OUSE (II....... QMI...... nIfMt 1711. ... - ...... Cumberland _? ,?.o ::;;,..-=:.::::.. MOTHER.SH.....jF...._.~s,.._ ,.. Naoml. Burkho.Loer ''''~T~~~,~cm'sn~~ 17013 - PI.ACE Of' OISPOS1tIOll.H......~.... c......,.. LOCRIOlI.~. _. Z1p~ ..ou.o. "'- Cumberland Valley Mem. .,.. HAMEANO_SSrY"""'-lTY 'a. "..K) -.--" c:: Josephine Mandalino Mi Ml..ron ..", 17.. s..te - ,.. IHFOAMAHT'SHAMECT_ John Henry Josephine Henry - MEtHOO OF OIS1'OSrTlOH _&J "'.........0 __$1...0 ...... PA l: ~,.,J /_'~ ~ c:.""P.o DUE 1O{OA /oS A CONSEQUENCE ~ WERE AUTOPSY FINDINGS """'-'8LE PllIOR 10 COMP<nIOH Of' CAUSE OF 0EIl0l? MAHNER Of OEATH ....0 ...0 - - - ~ o DATE OF IHJUAY l........!loy._' tiME OF INJURY INJURY R WOfV<? DESCRIBE HOW INJURY OCCURRED. Could not be detenrnned o o o PlACEOFtNJURY."'homI.tam'l......tacIory.otftce M. _OIC.I~ :lOa. _ 0 ...0 - "--'''' REGISTRAR'S SIGNATURE AND N ~. ~b,)..~~~~ ~ll~\lol LOC....ION -. CiIyIlowo,. SoaIOl 3Ol. StGNRURE AND TI1l.E OF CERTIFIER o "b. ~ lICENSE NUMBER o .... ftt.1j O~ 6 J ~ 1 . t- ,," I.r; p/ NAME AND AOOAESS Of' PERSON WHO COMJ'UTED CAUSE "" (ham 171 Type Of Pfinl .s. tJ." ~ J.f7</ ~ ,/?? ~ 032. frp W"'/~ tr.'ri~~ #...1 ~~.r~ DATE FILED IMonIh. Day. '\lQr1 ~~(.,\~aal _ 'Ib. Cl.RTWIUI rCttck anty one! .CblTFY1HGPHYSfCf4H(~c:ertlyinqeausedddCtt.".....~P"\lISlC."hft",~ cseillhanocanD'elednem 231 ToIhe~of...,~..athoceurr.dd\M..Ihe~.(.).ndft\."ne'.. ....ted.................... '................... ...... ....... 21. ."'OHQUNCIHG AND CERTIn'INCJ PHYSICIAN {F'hysIcIM both pronounell"lO dedi and ~ Ioc...,. of oeath' Te the..... of my kftO'llMdQft. death occur,. at the dine, .... and ,lacs. _nd due 10 ttM uuM(s} and "'_"net'.. .,.tl4.. . . " .. . . . . . . . . . . . . . . . .. . ."EDICAL EXAMINER/CORONER On the ba.', 0' uemlttatlott and/or Inv..U".llkm. m my opInJon, d..th occurred .t the lime. de.e. anet place. and due to the cau'.(I} and "'ann... al .ated.................................................................................................. 3'.. 7"/" /i.? / ?.# ,7'/3: LAST WILL AND TESTAMENT I, JOHN E. HENRY, of 34 Otto Avenue, Carlisle, Cumberland County, Pennsylvania 17013, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall b~ paid by my personal representative out of my estate. 2. I authorize and empower my personal representative 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 representative is 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 representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, Josephine J. Henry. 4. If my spouse does not survive me by a period of sixty (60) days, then my estate I give, devise and bequeath as follows: A. To each of my grandchildren and great grandchildren, one item of their choosing from my personal property, my personal representative to resolve any conflicts between said beneficiaries; and all the B. Rest, residue and remainder as follows: 1.) 25% to my granddaughter, Teresa Henry; 2.) 25% to my grandson, Steven Henry; and all the 3.) Rest, residue and remainder to my grandson, Kevin Henry. 5. I nominate and appoint my spouse to be the personal representative of my estate, to serve without bond. If my spouse cannot or does not serve, then I appoint Kevin Henry to be the substitute personal representative, also without bond. 6. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this S I day of October, 2000. ~~R~ L I (SEAL) JOHN E. HENRY Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 4JLa/Ly(1 /3~~ ACKNOWLEDGMENT AND AFFIDA VIT WE, JOHN E. HENRY, JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~u~ JOHN E. HE J jlLz-<a/~ r/l fZ;M~a-- HEATHER A. BARBOUR COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :ss: Subscribed, sworn to and acknowledged before me by JOHN E. HENRY, the testator herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, witnesses, this J...L day of October, 2000. [-=---_...~ ,~ - \:: - CERTIFICATE OF NOTICE UNDER RULE 5.6~ Name of Decedent: HENRY, JOHN E. Date of Death: APRIL 4, 2001 Will No. 2001-0440 Admin. No. 21-01-0440 To the Register: I certify that notice of beneficial interest or estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 26, 2000. Name Address JOSEPHINE J. HENRY 34 OTTO AVENUE CARLISLE, PA 17013 Notice has now been given to all persons entitled t ereto under Rule 5.6(a) except: None May 11, 2001 35 East High Street, Suit Carlisle, PA 17013 717 -243-6090 Attorney for Estate of John E. Henry 0/-0/- .<./-</0 COMMONWEALTH OF PENNSYLVANIA: :55: COUNTY OF CUMBERLAND . . JOSEPHINE J. HENRY, being duly sworn according to law, deposes and says that she is the executrix of the estate of JOHN E. HENRY, late of South Middleton Township, Cumberland County, Pennsylvania, deceased, and that the within inventory made by her, the said executrix of the entire estate of said decedent, consisting of all of the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the inventory represent its fair value as of the date of decedent's death. ~H;tR~.{4~ Executrix / INotarial Seal ] Harold S\lrwln III, Not Public Carlisle Bom.~land Countv My Commission Expires Sept. ~2':.200,~ Member, pennSYIVaaa !.I,ssociation or NOtaries APRIL 2001 Date of Death: Day Month Year INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplemental inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. Inventory of the real and personal estate of JOHN E. HENRY, deceased 1. ALLFIRST BANK - Checking Account No. 42292964 $ 2,462 49 . . ~_.," TOTAL $ 2,462 49 /b-.:JJ9-~ OFFICIAL U.. ONLY REV-1500 6)( (6-00) COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 RI!Y.1500 INHI!RITANCE TAX RETURN RI!SIDI!NT DI!CEDI!NT 'IL. NUM.... 21 01 COUNTY CODE YEAR 0440 NUMBER DECEDE NAME (lAST, FIRST, AND MIDDlE INI tAL) HENRY, JOHN E. 5 ClAL E URITY NUMBER 189 - 09 - 4271 (I APPLICABLE) SURVIVING POUSE' DA OF BIRTH AUGUST 9,19126 DA. F DEATH APRIL 4, 2001 NAME (LAST, FIRST AN MIOOL INITIA) tAL SE URITY NU SER _ 3. Remainder Return (dates of death p~or to 12-13-82) _ 5. Federal Estate Tax Return Req _ 8. Total No. of Safe Deposit Boxes _ 2. Supplemental Return l 1. Original Return _ 4a. Future Interest Compromise (for dates of death after 12-12-82) _ 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 4. Limited Estate ..1L 6. Decedent Died Testate (Attach copy of Will) EX. A _ 9. Litigation Proceeds Received _ 11. Election to tax (Sec. 9113(A)) (Attach Sch 0) COMPLETE MAILING ADDRESS 35 EAST HIGH STREET, SUITES 201/202 CARLISLE. PA 17013 NAME HAROLD S. IRWIN, III TELEPHONE NUMBER 111-243-6090 1. Real Estate (Schedule A) OFFICIAL USE ONLY (1) (2) 0.00 0.00 0.00 0.00 2,462.49 0.00 0.00 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages and Notes Receivable (Schedule D) (4) 5. Cash. Bank Dep & Mise Personal Property (Schad E) (5) (6) 6. Jointly Owned Property (Schedule F) 7. Transfers I Misc. Property(Schedule G) (Schedule L) (7) (8) 8. Total Gross Assets (total Lines 1-7) 2,462.49 9. Funeral Expenses & Administrative Costs (Sched H) (9) 5,923.00 0.00 10. Debts, Mortgage Liabilities & Liens (Schedule I) (10) (11) 5,923.00 (12) 0.00 (13) 0.00 (14) 0.00 x. - = (15) 0.00 x._ = (16) 0.00 )( .12 = (17) 0.00 )( .15 = (18) 0.00 (19) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amount of Line 14 taxable at the spousal rate '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 Decedent's Complete Address: STREET ADDRESS 34 OTTO AVENUE CITY I STATE I ZIp CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 line 18) (1) $ 2. Credits I payments A. Spousal Poverty Credit 8. Prior Payments C. Discount $ 3. Interest I Penalty if applicable O. Interest E. Penalty Total Credits (A+8+C) (2) $ TotallnteresUPenalty (D+E) (3) 4. If 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 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5A) (5) $ 8. Enter the total of Line 5+5A. This is the BALANCE DUE. (58)$ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Old decedent make a transfer and: Yes a. retain the use of Income ofthe property transferred; ................................... 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? ............................... 2. If death occurred on or before December 123,1982, did decedent withIn two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................... 3. Old decedent own an IlJn trust for" or payable upon death bank account or security at his or her death? ...................................................................................................... 4. Old decedent own an individual retirement account, annuity, or other non-probate property? ...... No --K... -X- -X- -X- N/A -X- -1L 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 pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowtedge and belief, it is true, correct and complete. Declaration of preparer other than personal representative is based on all information of which preparer has kn wled e. RETURN SIGNATURE 0 AL REPRESENTATIVE 'lATE MAY /. ,2000 I ADORE 35 EAST HIGH STREET, CARLlS MAY ,2000 For dates of death on or after July 1, 19 fore 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. Section 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. Section 9116 (a){1.1 )(ii)]. The statute does not exemot 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 twenty-one years of age or younger at death to or for the use of a natural parent, an acloptive parent, or a stepparent of the child is 0% [72 P.S. Section 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. Section 9116 (1.2)[72 P.S. Section 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. Section 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. REV-1502 EX + (12-85) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY SCHI!DULI! A RI!ALI!STATI! FILE NUMBER 2001 - 0440 (Property jolntly-owned wtth Right of Survivorship must be dl.closed on Schedul. F) All ....I..tat. .hould be reported .t fair mark.t valu. which I. defined a. the price at which property would be exchanged between a willing buy.r and a willing ..II.r, n.lther being compelled to bUY or ..11, both having reasonabl. knowledg. of the relevant facts. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH NONE TOTAL (Also enter on Un. 1, Recapitulation) NONE (N more space is needed, Inset! eddltlonel sheets of same slz..) REV-1503 eX + (4-86) COMMONWEA~TH OF PENNSY~VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY SCHBDULI! B STOCKS AND BONDS FI~E NUMBER 2001 . 0440 (All proDertv olntlv-owned with Rlaht of SurvlvorshlD must be disclosed on Schedule F.) ITEM DEliCRIPTION NUMBER VA~UE AT DATE OF DEATH NONE TOT A~ (Also enter on Une 2. Recapitulation) NONE (If """" space is needed, Insert eddlfJon., sheets of same size.) REV-1504 EX + (3-92) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY ITEM NUMBER NONE SCH~DUL~ C CLOS~L Y H~LD STOCK PARTN~RSHIP AND PROPRI~TORSHIP FILE NUMBER 2001 . 0440 TOTAL (Also enter on Une 3, Recapitulation) (If more space Is needed. insert additional sheets of same size.) NONE REV-1507 EX + (~) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIIDULII D MORTGAGIIS AND NOTIIS RIICIIIVABLII ESTATE OF JOHN E. HENRY FILE NUMBER 2001 - 0440 fAil Droperty Jolntlv-owned with Right 01 Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Une 4, Recapitulation) NONE Iff mOI8 space is needed, Inset! additional shasts of same siza.) REV-1508 eX + (2-87) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHI!DULI! I! CASH, BANK DI!POSITS AND MISCI!LLANI!OUS PI!RSONALPROPI!RTY ESTATE OF JOHN E. HENRY FILE NUMBER 2001 . 0440 IAII crooertv jclntlv-owned with Rlcht of Survivorship must be disclosed on Schedule F.l ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH 1. ALLFIRST BANK - Checking Account No. 42292964 (Value based on attached bank statement - Exhibit B) $ 2,462.49 TOTAL (Also enter on Une 5. Recapitulation) $ 2,462.49 (If more space is needed, inset! edd1lioneJ sheets of same size.) REV-1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY SCHI!DULI! F .JOINTLY.OWNI!D PROPI!RTY FILE NUMBER 2001 . 0440 Jolnllenanl(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. Jolnlly-owned pronertv: ITEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL DECD'S DOLLAR NO. FOR MADE VALUE % INT. VALUE OF JOINT JOINT OF ASSET DECEDENT'S TENANT INTEREST ALL OTHER PROPERTY WAS JOINTLY OWNED WITH JOSEPHINE J. HENRY, THE DECEDENrs SURVMNG SPOUSE TOTAL (Also enter on Une 6, Recapitulation) NONE (If more space is needed. Insert additional sheets of SBme size.) REV-1510 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY 8CH~DUL~ G TRAN8F~R8 FILE NUMBER 2001 . 0440 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM DESCRIPTION OF PROPERTY EXCLUSION TOTAL DECD.'S DOLLAR NUMBE Include name of tfut transfetee. their reIatJotl$hlp to decedent. dale of transfer VALUE % OF INT. VALUE OF R OF ASSET DECEDENT'S INTEREST NONE TOTAL (Also enter on Une 7, Recapitulation) NONE (" more spacs ;s needed, insert additional sheets of same size.) REV-1511 EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHI!DULI! H FUNI!RAL I!XPI!NSI!S, ADMINISTRATIVI! COSTS AND MISCeLLANI!OUS I!XpeNSeS ESTATE OF JOHN E. HENRY FILE NUMBER 2001 . 0440 ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1. HOFFMAN - ROTH FUNERAL HOME - Funeral Bill 5,409.50 2. 3. 4. B. Administrative Costs: 1. Personal Representative Commissions: Social Security Number of Personal Representative:: Year Commissions Paid: 2. Attorney Fees: HAROLD S. IRWIN, III 437.50 3. Family Exemption: Claimant Relationship Address of Claimant at detedenfs death: Street Address City State Zip Code 4. Probate Fees: REGISTER OF WILLS 45.00 C. Miscellaneous Expenses: 1. REGISTER OF WILLS. File Inventory and Appraisement 25.00 2. HAROLD S. IRWIN, . Notary Fees 6.00 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. TOTAL (Also enter on Line 9. Recapitulation) S 5,923.00 I" more space Is needed. inset! sdditkJnsl sheals of seme size.) REV-1512 EX + (1-93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY SCH~DUL~ I D~BTS OF D~C~D~NT, MORTGAG~S, LIABILITI~S AND LIENS FILE NUMBER 2001 - 0440 ITEM NUMBER DESCRIPTION AMOUNT NONE . TOTAL (Also enter on Une 10. Recapitulation) $ 629.72 (If mom space is needed, insert additional sheets of same size.) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN E. HENRY SCHeDULe J BeNeFICIARies FILE NUMBER 2001 . 0440 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. JOSEPHINE J. HENRY SURVIVING SPOUSE 100% 34 OTTO AVENUE CARLISLE, PA 17013 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on Une 13. Recapitulation) NONE (If more space ;s needed. insert additional sheets of same size.) /-AfT WILL 4~D J:ESTAM-eNT I, JOHN E. HENRY, of 34 Otto Avenue, Carlisle, Cumberland County, Pennsylvania 17013, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall bill paid by my personal representative out of my estate. 2. I authorize and empower my personal representative 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 representative is 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 representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, Josephine J. Henry. J 4. If my spouse does not survive me by a period of sixty (60) days, then my estate I give, devise and bequeath as follows: A. To each of my grandchildren and great grandchildren, one item of their choosing from my personal property, my personal representative to resolve any conflicts between said beneficiaries; and all the IN WITNESS WHEREOF, I have hereunto set my hand and seal this S, I day of October, 2000. ~~Rn~ (SEAL) B. Rest, residue and remainder as follows: '. 1.) 25% to my granddaughter, Teresa Henry; 2.) 25% to my grandson, Steven Henry; and all the 3.) Rest, residue and remainder to my grandson, Kevin Henry. 5. I nominate and appoint my spouse to be the personal representative of my estate, to serve without bond. If my spouse cannot or does not serve, then I appoint Kevin Henry to be the substitute personal representative, also without bond. 6. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. JOHN E. HENRY Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. rdf-a/L 54. /$~ ~, Jjf,:Ktloft('RD(~-'tII"ENT M-P AfF-'.04YJJ: WE, JOHN E. HENRY, JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~t!J#v~~ JOHN E. HE J ,yi 1(/ a/~ 4 fZ:t"'~~ HEATHER A. BARBOUR COMMONWEALTH OF PENNSYLVANIA :55: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by JOHN E. HENRY, the testator herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, witnesses, this::)..L. day of October, 2000. t1J!~ ~;,",,<;,~;.::-=-:"1\ H:,~'~ld ~,",', ,. ':-:~I "}1.r~"I': C,li~:,,~'J -."':"), ;:,.~ -: 2' ~(~.~ ,;;~;r':'.' My r:CIT:~~.~'- r__~., _:':":':'~.:::':":::!.. :~::~ Memcer. j-'."n,:.;.:.-;",; .~... ....;.,~; ;-iL.Ufl'J3 IMII 05/10/01 JOHN E HENRY OR JOSEPHINE 34 9TTO"AVE DATE 03/21 03/21 03/22 03/26 03/27 04/02 04/03 04/03 04/06 04/09 04/09 04/10 PF1 - J HENRY BEGINNING BALANCE 1889.32 CK NBR 3526 3527 3528 3529 3530 3533 PAGE 3532 3541 FWD DDA STATEMENT HISTORY 10.41.01 PAGE ACCOUNT 001-000-0000-0042292964 DATE LAST STATEMENT 02/20/01 DATE THIS STATEMENT 05/10/01 *****DDA TRANSACTIONS***** CHECKS/OTHER DEBITS DEPOSITS/OTHER CREDITS NBR TOTAL AMOUNT NBR TOTAL AMOUNT 34 1045.75 2 1500.00 AMOUNT TP TRANSACTION DESCRIPTION 25.00 CHECK 5.93 CHECK 54.00 CHECK 5.00 AUTOMATED TRANSF 10.48 CHECK 5.00 AUTOMATED TRANSF 750.00 DEPOSIT 89.12 CHECK 36.00 CHECK 5.00 AUTOMATED TRANSF 2.92 CHECK 75.00 CHECK PF2 - PAGE BKWD 3 ENDING BALANCE 2343.57 BALANCE 1882.02 1876.09 1822.09 1817.09 1806.61 1801.61 2551.61 2462.49 2426.49 2421.49 2418.57 2343.57 G STATUS REPORT UNDER RULE 6.12 Name of Decedent: JOHN E. HENRY Date of Death: APRIL 4,2001 Will No. 21 - 01 - 0440 Admin No. 2101 - 0440 Pursuant to Rule 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 X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 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 No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to is r ort. Harold S. Irwin, III Attorney for Estate 0 June 21, 2001 35 East High Street Carlisle, PA 17013 717 -243-6090 \ I" .. C:;.:2, S?- 6 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 )'0i.~ (JVv) ~ REV-1547 EX AFP <lZ-DDl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HAROLD S IRWIN STE 201/202 35 E HIGH ST CARLISLE DATE ESTATE OF DA TE OF DEATH FILE NUMBER COUNTY ACN 06-18-2001 HENRY 04-04-2001 21 01-0440 CUMBERLAND 101 JOHN E Amount Remitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i5'4-j-Ex-AFP-fi'2=ooY-NcfficE--oF-YNHEifiTANCE-YAX-APPRAISEifENT~--AU.-OWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HENRY JOHN E FILE NO. 21 01-0440 ACN 101 DATE 06-18-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 2,462.49 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 5,923.00 .00 (11) (12) (13) (14) NOTE: .00 .00 .00 .00 X 00 = X 045 = X 12 = X 15 = NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 2,462.49 5.923 00 3,460.51- .00 3,460.51- (19)= .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIp. (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)