HomeMy WebLinkAbout07-14-06
DALEY, ZUCKER & GINGRICH, LLC
ATTORNEYS AT LAw
UNDSAYGINGRICH MACU.Y
AlTORNEY AT LAW
\717) 657-4795 EXT. 15
EMAIL: LMACLAY@DZGLAW.COM
OF COUNSEL: KATHLEEN CAREY DALEY. ESQUIRE
PATRICIA CAREY ZUCKER. ESQUIRE
KATHLEEN MISTURAK-GINGRICH. ESQUIRE
PATRICIA A. PAlTON. OFFICE MGR.lPARALEGAL
SUSAN M. HUDSON. PARALEGAL
MICHELLE M. BROSS. LEGAL ASSISTANT
JANET M. FISHER. LEGAL ASSISTANT
July 13,2006
Via Federal Express
Office of the Register of Wills
Orphans' Court Division
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Richard Hampton
File No. 2005-01076
Dear Sir or Madam:
Please find enclosed an original and two copies of a Pennsylvania Inheritance Tax Return
and an Inventory to be filed in the above-referenced Estate. Please return a date-stamped copy of
the Return and the Inventory to me in the enclosed self-addressed, stamped envelope.
I have also enclosed the following checks: (1) Check No. 99 in the amount of $1,672.88
in payment of inheritance tax due; (2) Check No. 100 in the amount of $125.00 for payment of
outstanding probate fees; and (3) Check No. 481 in the amount of $30.00 for payment of filing
fees for the Inventory and the Return.
Thank you for your assistance. Should you have any questions or if you would like to
discuss this matter further, please do not hesitate to contact me or our paralegal, Susan Hudson.
Very truly yours,
DALEY, ZUCKER & GINGRICH. LLC
,;(;jtCLL<":r-J14jV' i J)wc( ~Jl<i l. (~
Lindsay Gingrich Maclay
LGM/smiz
Enclosure
cc: Kelly Greensmitiz, Executrix
1 ~2 9 5c E: f~ r~'Y C f\' i \; . r"l 1<
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF II,DIVIDUAL TAXES
DEp-:- 1
HARRISBURG, f~',2.. 1"7 ~ 28-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GREENSMITH KELLY
925 APPENZELL DRIVE
HUMMELSTOWN, PA 17036
_~u____ told
ESTATE INFORMATION: SSN: 162-26-2518
FILE NUMBER: 2105-1076
DECEDENT NAME: HAMPTON RICHARD
DA TE OF PAYMENT: 07/14/2006
POSTMARK DATE: 07/1 4/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 10/17/2005
NO. CD 006968
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,672.88
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 99
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$1,672.88
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Receipt Time:
Receipt No. :
7/14/2006
11:17:57
1045019
HAMPTON RICHARD
Estate File No. :
Paid By Remarks:
2005-01076
J ERIC GREENSMITH
AJW
------------------------ Receipt Distribution ------------------------
Fee/Tax Description
INH TAX RETURN
INVENTORY
Check# 481
Total Received.........
Payment Amount
15.00
15.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
$30.00
$30.00
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
Richard Hampton
No.
::>005-01076
also known as
Date of Death ] 0/17/200'5
, Deceased
Social Security No. 162-26-2518
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Name of
Attorney:
Personal Representative:
Lind~ay Gingrich Maclay
Kelly Green~mith
1.0. No.:
87954
Address:
1029 Scenery Drive
Dated .July 1~, 2006
Harri~bL1rg, PA 17109
Telephone:
717-657-4795
Description Value
1. 2002 Country Coach Motor Home 112,000.00
2. Prudential Annuity, Discovery Classic 89,159.68
3. Prudential Annuity, Discovery Preferred 43,304.34
4. J.C. Penney Stock 34,921.50.
5. Pharmaceutical Stock 12,887.11
6. Household goods and furnishings 125.00
7. Merrill Lynch dividends and refunds 173.12
8. Class Action Settlement 34.64
9. AARP Insurance Refund 181.00
10. 2005 income tax refund (federal) 1,472.00
11. M& T Bank Checking Account No. 3957400611 14,596.39
$308,854.78
"",)
,'I
)
,
(JI
Attach Additional Sheets if necessa
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of t e personal representative, include
the value of each item, but such figures should not be extended into the total of the Inventory.
--.J
15056051058
REV-1500 EX (06-05)
PA Department of Revenue *'
Bureau of Individual Taxes .l1Ii1.
PO BOX 280601 .
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Date of Birth
162-26-2518
10/17/2005
04/26/1934
Decedent's Last Name
Suffix
Decedent's First Name
MI
Hampton
Richard
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
. 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
.
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Lindsay Gingrich Maclay
Firm Name (If Applicable)
(717) 657-4795
REGISTER OF WILLS USE ONLY
- "
I
Daley, Zucker & Gingrich, LLC
First line of address
1029 Scenery Drive
)
.)
Second line of address
City or Post Office
State
liP Code
DATE FILED
.)
-, t
Harrisburg
PA
17109
i..... .
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, includin9 accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
=l
1"103(;;
f't. I 7t 0 '1
INAL FORM ONLY
fAJE I -. /
'7+-il-t~__-
Side 1
L
15056051058
15056051058
--.J
--.J
15056052059
REV-1500 EX
Decedent's Name:
Richard
Hampton
RECAPITULATION
1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - 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_
16. Amount of Line 14 taxable
at lineal rate X.O 45 292,577.36
15.
16.
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
162-26-2518
Decedent's Social Security Number
47,808.61
246,449.78
14,596.39
308,854.78
10,194.30
6,083.12
16,277.42
292,577.36
292,577.36
13,165.98
13,165.98
15056052059
--l
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Richard Hampton
STREET ADDRESS
416 Parkside Road
File Number
DECEDENT'S SOCIAL SECURITY NUMBER
162-26-2518
CITY
Camp Hill
I STATE
PA
I ZIP
I 17011
I
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
13,165.98
11,493.10
Total Credits (A + B + C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
11,493.10
TotallnteresVPenalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
1,672.88
A. Enter the interest on the tax due.
1,672.88
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D [K]
b. retain the right to designate who shall use the property transferred or its income; ............................................ D [K]
c. retain a reversionary interest; or.......................................................................................................................... D [K]
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [K]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [K]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [K]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [K] D
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 after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (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 zero (0) percent
[72 P.S. 99116 (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 twenty-one 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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 PS. s9116(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.
illast lIill ann QLentam~ut
OF
RICHARD Hl\MP'lUN
BE IT REMEMBERED, that I, RICHARD Hl\MP'lUN, of R.D. 1, Box 132,
Wellsville, York County, Pennsylvania, being of sound mind, memory and
'. understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making null and void any and all Wills and
Testaments and writings in the nature thereof by me, at any time heretofore made.
ITEM 1: I direct that all my just debts and funeral expenses be paid as
soon after my demise as may be convenient.
ITEM 2: All the rest, residue and remainder of my Estate of whatsoever
nature and wheresoever situate, whether it be real, personal or mixed, including
any insurance policies therefore, property over which I have a power of
appointment, and proceeds fran any insurance policies payable to my estate, I
give, devise and bequeath unto my wife, BONITA L. HAMPTON, absolutely, provided
she survives me for a period of thirty (30) days.
ITEM 3: Should my wife, BONITA L. HAMP'lDN, predecease me, fail to
survive TIe for a period of thirty (30) days, or should we die simultaneously, I
then give, devise and bequeath my entire residuary estate unto my daughters, Kelly
Hampton Greensmith and Toni R. Hampton, in equal shares per capita.
ITEM 4: I direct my hereinafter named executrix to pay all inheritance,
estate, succession and legacy taxes of whatsoever nature and kind, to which my
Estate or the transfer of any property passing hereunder or otherwise passing by
reason of my demise, may be subject to charge such taxes against my residuary
estate, it being my intention that none of the aforesaid taxes, either federal or
state, on any property required to be included in my gross estate, under the
( SEAL )
provisions of any state or federal law now in force or hereafter enacted, shall be
prorated among the persons interested in my estate to whan such property is or may
be transferred to whom any benefit accrues.
ITEM 5:
I appoint my wife, BONITA L. HAMP'lDN, as executrix of this my
Last Will and Testament. Should my wife predecease me, fail to qualify, cease to
act or renounce probate, I then appoint my brother-in-law, Charles Vere BaJmer, as
alternate Executor of this my Last Will and Testament, and in the event he is
,unable to serve in this capacity, I then appoint, Glenda M. Wethington, as
alternate Executrix of this my Last Will and Testament.
ITEM 6:
I direct that my Executrix, guardian, or their successors shall
not be required to give bond for the faithful performance of their duties in any
jurisdiction.
,/} Sf-
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ex I day
~Cc-c~~ ' 1993.
of
WITNESS:
/1 " i'
/ i j' ~
/,'} /' -'1/-'
ji{t,." ~/ L ('04 , (SEAL)
RICHARD HAMPTON
COMMONWEALTH OF PENNSYLVANIA
COUNTY
OF a,-~n.d-
58
/ Jr;. ~E, '/ i!JztU I
/)/P IA I 17Uth IV
v,W
J/tUtlct
/
fl.
?
, the (testator/testatrix)
and the '"itnesse::., reBpectively, whose [Jdmes aLe signed to the at-
tached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the (Testator/testatrix)
signed and executed the instrument as (his/her) Last Will and Testa-
[Tlent and that (he/she) signed willingly ( willingly direc~ another
to sign) and that (he/she) executed it as (his/her) free and volun-
tary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the (testator/testatrix)
signed this Last Will and Testament as witness and that to the best
of their knowledge, the (testator/testatrix ) was at that time eigh-
teen (18) years of age or older, of sound mind and under no constraint
or undue influence.
JljLf2LL~
~.L.~
/
,r) . ~
YnJh~r=
WITNESS
~u~ t
~
vHTNESS
Sworn to and SUlb"'.cribe>d to. be. fore
01 ( 5 1- I I UCi3
~ DAY OF -Clt~ ( It..
. - Ltc~ {/ttL J
me this
Notary
THE CENTRAL PENN BUSINESS JOURNAL
Proof of Publication
Under the Pennsylvania Newspaper Advertising Act
45 Pa.C.S. SlOl, et seq.
Commonwealth of Pennsylvania }
ss}
County of Dauphin }
Rebecca Cover, being duly sworn according to law, deposes and says:
That she is the Controller of and duly authorized agent for JOURNAL PUBLICATIONS, INC., a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 101 N. Second Street,
in the city of Harrisburg, County of Dauphin, State of Pennsylvania; that the THE CENTRAL PENN BUSINESS JOURNAL, a
newspaper of general circulation distributed and circulated in Dauphin, Cumberland, Lancaster, Lebanon and York counties, is
published by the said JOURNAL PUBLICATIONS, INC. at 101 N. Second Street, in the City, County and State aforesaid; and that
THE CENTRAL PENN BUSINESS JOURNAL was established September 9th, 1984 and has been continually published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in the weekly
editions/issues of the CENTRAL PENN BUSINESS JOURNAL which appeared on the 20th, 27th day(s) of January and on the 3rd
day(s) of February 2006. That neither she nor said Corporation is interested in the subject matter of said printed notice or advertising,
and that all of the allegations of this statement as to the time, place and character of publication are true; and
This is a statement published by JOURNAL PUBLICATIONS, INC.
PUBLICATION ~~J~\~)L0 C~'-- /
COpy Rebecca Cover
ESTATE NOTICE
NOTICE IS HEREBY GIVEN that letters testa-
mentary or of administration have been grant-
ed in the following Estate. All persons indebt-
ed to the said Estate are required to make
payment, and those having claims or demands I
to present the same without delay to the
administrators, executors, or their attorneys
named below.
Sworn to and subscribed before me this p day of Jr' 2006 A.D.
~
ttf~UBLIC
ESTATE OF RICHARD HAMPTON, late of Camp
Hill, Camp Hill Borough, Cumberland County
Pennsylvania, died on October 17, 2005:
Administrator/Executor: Kelly Greensmith.
Attorney: Lindsay Gingrich Maclay, Esquire,
Daley, Zucker & Gingerich, LLC, 1029 Scenery
Drive, Harrisburg, PA 17109-5322.
COivitviONViEALTH OF PENNSYLVANIA
I Nnt"c"jal Seal
qOl1na ~fhanl; ....:iier, Not~ Public
"~. - ....'-j<'.'\.I....-.', ' ....Jl
'. 1 ~lIXof:,~al;;:~~~.E>, i~,~Jr~~ County
L:~~.".::~~.::.:l~.~:::::..::.~::::~~.":~~..:....l 0, 2008
Publisher's Receipt for Advertising Cost
JOURNAL PUBLICA nONS, INC., publisher of the CENTRAL PENN BUSINESS JOURNAL, newspaper of general circulation, distributed and
circulated in Dauphin, Cumberland, Lancaster, Lebanon and York counties, hereby acknowledges receipt of the aforesaid notice and
publication costs and certifies that the same have been duly paid.
THE CENTRAL PENN BUSINESS JOURNAL
Re: Estate of Richard Hampton
Daley, Zucker & Gingerich, LLC
1029 Scenery Drive
Harrisburg, PA 17109
Attn: Susan Hudson
By................................................................
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEAL TH OF PENNSYL VANIA
ss.
COUNTY OF CUMBERLAND
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
Viz
~/J-N()-41<V ~. oto~ , ...;;T,4A/tJfiRC/ /8, e:::(oo6 J ...z-;9A/v/1-R.Y c:2b. c::20t:J0
./ ... -
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Hampton, Richard, dec'd.
Late of Camp Hill, Camp Hill Bor-
ough.
Executrix: Kelly Greensrnith.
Attorneys: Lindsay Gingrich Ma-
clay, Esquire, Daley, Zucker & Gin-
grich, LLC, 1029 Scenery Drive,
Harrisburg, PA 17109-5322.
~
j isa Marie Coyn , Editor
I
SWG~~TO AND SUBSCRIBED before me this
d?O r. day of J/9,A/tJ ~RY/ D2LJtJtO
~'A1) L. ~rJ!/u
C~'C"C"c:1"T:otary=~:t:. '.=C.C' . c'~
REV-1503 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Hampton, Richard
FILE NUMBER
2005-01076
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
J. C. Penney Stock
34,921.50
2_
Pharmaceutical Stock
12,887.11
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
47,808.61
41030100042910009008
Page 1 ot 2
@
Shareholder Of:
Mellon Investor Services
A Melfon Financial Company".\!
P.O. Box 3336
South Hackensack, NJ 07606-1936
J.C. PENNEY COMPANYINC
INVESTOR SERVICES PROGRAM
STATEMENT PRINT DATE: 11/04/2005
CUSIP: 001-750-70816010
SYMBOL: JCP
ACCOUNT KEY: HAMPTON-..RICH-OOOO
INVESTOR 10: 125209614452
0004291 01 ME 0.309 "AUTO T2 0 4103 1701.1-212716 C01 BlYAI -1234 -
111.11 1..,1" 11I11'" '" II 111,1",11 111.11,.,1,..11,1111.,,11 I
RICHARD HAMPTON
416 PARKSIDE RD
CAMP HILL PA 17011-2127
FOR QUESTIONS CONCERNING YOUR ACCOUNT, PLEASE CALL
1-800-842-9470.
Year- To-pate Account Su'!!!!'ary __ ~____'I
AS OF: 11/0212005 CI\SH .
TOTAL MARKET VALUE ($) CLOSING PRICE ($) INVESTMENTS ($)
34,921.50 51.4500
TOTAL ($)
337.28
Save this Statement for Tax Purposes
'DIVIDENDS . r ~ET A;~UN':---I
TAX wrrHHELD ($) , AMOUNT 1"0 INVf:ST ($) ifNi.:5TEC (~)
337.28 337.28
SALE OF PLAN SHARES ($) CERTIFICATED SHARES HELD SHARES HELD BY
GROSS PROCEEDS TAX WITHHEL.D SHARES HEL.D BY YOU BY PL.AN OTHER PLAN(S)
TOTAL
SHARES
0.32
436
242.7463
678.7463
c
t A to Ot I "
t"
urren c IVIfV norma Ion
RECORD DATE TRANSACTION DIVIDEND SHARES ACQUIRED CASH TOTAL
PAYABL.E DATE DESCRIPTION RATE OR WITHDRAWN INVESTMENT ($) GROSS ($)
10/10/2005 COMMON DIVIDEND 0.1250000 1.6889 84.63
11/01/2005
PARTICIPATING RECORD DATE DISTRIBUTION
TAX TRADING FEES PAID BY ($1 SERVICE FEES PAID BY ($) TOTAL CERTIFICATED SHARES SHARES HELD SHARES HELD BY TOTAL.
WITHHELD ($) COMPANY SHAREHOLDER COMPANY SHAREHOLDER UET($) HELD BY YOU BY PLAN OTHER PLAN(S) SHARES
0.10 1.50 84.63 436 241.0574 677.0574
Year-To-Date Transaction Detail
DATE TRANSACTION CASH NET TRADING SERVICE AMOUNT PRICE PER SHARES ACQUIRED SHARES HELD
DESCRIPTION INVESTMENT ($) DISTRIBUTION ($) FEES ($) FEES ($) INVESTED ($) SHARE ($) OR WITHDRAWN BY PLAN
BALANCE FORWARD 235.8044
02/01/05 COMMON DIVIDEND 83.98 0.12 1.50 83.98 42.6400000 1 .9695 237.7739
05/02/05 COMMON DIVIDEND 84.22 0.11 1.50 84.22 47.1100000 1.7877 239.5616
08/01/05 COMMON DIVIDEND 84.45 0.09 1.50 84.45 56.4574000 1.4958 241.0574
11/01/05 COMMON DIVIDEND 84.63 0.10 1.50 8.~_. 50.1091000 ........1.&889'---_ 242.7461.
----------------------------------------------------------------------------------------------------------------------------------
J.C. PENNEY COMPANY INC
CUSIP: 001-750-70816010
ACCOUNT KEY: HAMPTON--RICH-OOOO
RICHARD HAMPTON
416 PARKS IDE RD
CAMP HILL PA 17011-2127
Partial Withdrawal (Continue Plan Participation)
Additional Cash Investments
Issue a certificate for this
number of shares:
I I
[_____J
Write the amount enclosed:
L__J
Sell this number of shares:
Make check payable to:
JCPENNEY/MELLON BANK
YOU MAY INCREASE YOUR SHARES
WITH OPTIONAL CASH INVESTMENTS
OF $25 UP TO $10,000 PER MONTH.
Full Withdrawal (Terminate Plan Participation)
D
D
Sell all plan shares.
Issue a certificate for all full shares
and a check for fractional shares.
Deposit of Certificates
Deposit the enclosed number
of shares:
I
_J
All oWler(s) must sign and date above
( )
Contact Nurrber
7575
125209614452
00175070816010HAMPTON--RICH-0000IR00183
Individual
Investor Account
.,. enill Lynch,
Pierce, Fenner & Smith Inc.
Member, Securities Investor Protection Corporation (SIPC)
.:fu:l,-,.,.. Il j_r...-~;{~ll,''''~~~
ACCOUNT' IF/A, IPAGE ,
2AR 26976 1019 1
STATEMENT PERIOD
03/27/04 TO 06/25/04
CONTACT THE FINANCIAL INVESTOR
ADVISORY CENTER AT CRED IT LI NE
1-888-ML-INVEST
OFFICE SERVING YOUR ACCOUNT: TYPE
PO BOX 1528
PENNINGTON NJ 08534-1528 CASH
RICHARD HAMPTON AND
BONITA LOUISE HAMPTON DCSD JTW
416 PARKSIDE RD
CAMP HILL PA 17011-2127
FOR CUSTOMER SERVICE PLEASE CALL TOLL-FREE 1-888-ML-INVEST.
***** ACCOUNT SUMMARY
*****
OPENING BALANCE CLOSING BALANCE
$143.11CR $128.11CR
10 **GLAXOSMITHKLINE PLC ADR
80 **LILLY ELI CO
9 **MEDCO HEALTH SOLUTIONS
80 **MERCK&CO INC
TOTALS FOR PRICED INVESTMENTS
*****
DESCRIPTION
REPORTABLE DIVIDENDS
*****
TRANSACTION
03 27 OPENING BALANCE
03 30 Journal Entry
04 01 *Dlvldend
04 15 *Rpt Fgn Dlv
04 30 Check
06 10 *Dlvldend
06 25 Check
06 25 CLOSING BALANCE
*****
QUANTITY
-000016125
INVESTMENTS MONEY ACCOUNTS PRICED PORTFOLIO
$12759 $.00 $12,887.11
TAX INFORMATION SUMMARY
*****
THIS STATEMENT
YEAR TO DATE
$94.40CR
DAILY ACCOUNT ACTIVITY
$173.41CR
*****
DESCRIPTION
AMOUNT
LOW BALANCE FEE
MERCKIeCO INC
HOLDING 80.0000
GLAXOSMITHKLINE PLC ADR
HOLDING 70.0000
MONTHLY AMT ISSUED
LILLY ELI CO
HOLDING 80.0000
MONTHLY AMT ISSUED
$143.11CR
$15.00
$29.60CR
$36.40CR
$66.00
$28.40CR
$28.40
$128.11cR-'
CURRENT PORTFOLIO
*****
INVESTMENT DESCRIPTION
42.350
71 . 400
35.970
47.000
$2964 3.44
$5112 1.98
$323
$3760 3.14
$12759
$102
$113
$118
$333
JUNE 2004
1
C
FOR Ai'J EXPUNA -;/ON OF SYA1BOLS, ?LEASE SEE RP/ERSE SiDE
,: :"'Er.::'r. ..:\ :_-:o~ " :'~" : '.....II:::l;.\... .:.':',::':P ~""ED'p. --E.. ( .:F ;r;',' ,J.SCitEPM.C'=,:; ..:~ ":")~ ~.,.-, -"..."....~-...- ..-
','/rE,',; !.'A.....:r-iG ;,;,-:,.:p,;::-:: ::1; c.<>-r ",......,..,_.. ..-- -
H.-
REV-150S EX+ (6-9S)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hampton, Richard
FILE NUMBER
2005-01076
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. 2002 Country Coach Motor Home
2. Prudential Annuity, Discovery Classic
3. Prudential Annuity, Discovery Preferred
4. Household goods and furnishings
5. Merrill Lynch dividends and refunds
6. Class Action Settlement
7. AARP Insurance Refund
8. 2005 income tax refund (federal)
VALUE AT DATE
OF DEATH
112.000.00
89,159.68
43,304.34
125.00
173.12
34.64
181.00
1,472.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
246,449.78
Prudential Financial Retail Portal
. ~~~.
~--
Page 1 of 1
Prudential C~ Finaneial
-
HELP ! SITE v
Financial Professiona
12
" ~'~;^\Ui'>I-I'c; '......
)""\~...<.J~... '{ ~r~.
F1Np.NCIAL PLANN1NG~ PRODUCTS,~ SERV1CESl; NEWS & QUOTES;
OVERViEVV
FINANCIAL PLAN
INSURANCE
MUTUAL FUNDS
ANNUITIES
BROKERA.GE
PERSONAL
Annuities Summary
Prints
Fixed Annuities (as of 11/16/2005)
Product Name. Contract Number Contract Information
Your Contract Un
Action/Transaction
III Tax Forms
III Update Mv AddreE
III Self SEjfYice
Discovery Classic - E0256706
$89,159.68 Please select
Contract Fund
Value
Total Fixed Annuities $89,159.68
Frequently Asked
(FAQs)
Variable Annuities (as of market close, 11/16/2005)
Product Name - Contract Number Contract Information ActionlTransaction
Search answers to A
email us with your ql
III Find Answers! Err
Discovery Preferred Annuity - Contract Fund
E0003124 Value
$43,304.34 Please select
Discovery Select Annuity - E0177273 Contract Fund
Value
$116,176.20 Please select
Total Variable Annuities
$159,480.54
Grand Total
$248,640.22
Privacv and Business Inteqrity I Terms and Conditions
Securities products and services are offered through Pruco Securities LLC. a Prudential Financial company. Member SIP
Prudential Financial is a service mark of The Prudential Insurance Company of America, Newark,
NJ and its affiliates. @Copyright 2005 Prudential Financial, Inc, Newark, NJ, USA. 1\11 rights
reserved, Site for U.S. persons onlv.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
JAN 1 9 2006
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MACLAY LINDSAY GINGRICH
1029 SCENERY DRIVE
HARRISBURG, PA 17109
__nu__ fold
ESTATE INFORMATION: SSN: 162-26-2518
FILE NUMBER: 2105-1076
DECEDENT NAME: HAMPTON RICHARD
DATE OF PAYMENT: 01/17/2006
POSTMARK DATE: 01/13/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 10/17/2005
NO. CD 006219
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $11,493.10
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
LINDSAY MACLAY, ESQ
CHECK# 89
SEAL
INITIALS: RSK
RECEIVED BY:
TAXPAYER
$11,493.10
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
2005-01076
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Toni R. Rakoski
416 Parkside Drive, Camp Hill, PA 17011
Daughter
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A M&T Bank Checking Account No. 3957400611 29,192.77 50 14,596.39
I
,
TOTAL (Also enter on line 6, Recapitulation) $ 14,59639
(If more space is needed, insert additional sheets of the same size)
3957400611
11 & T FIRST
DEC.17-JAN.13}2006
1 OF 1
00
o 0430911 NI1 017
77907
RICHARD HAMPTON
TONI R HAMPTON
416 PARKSIDE RD
CAMP HILL PA 17011
DILLSBURG
29}192.77
I'OSTING ·
DAtE..
ACTIVITY
DEI'OSU$..INTEREST .. CHECKS. a OTHER
&..OTFlER..A.DD:ItloNS. .......SlJBtRA.CTI0NS
12-17-05 BEGINNING BALANCE
12-19-05 CLOSEOUT
29}192.77
$29}192.77
0.00
ENDING BALANCE
$0.00
DO YOUR TAXES WITH TURBOTAXCRJ ONLINECSI1J} BROUGHT TO YOU BY I1&T! IT"S EASY}
THERE IS NO SOFTWARE TO DOWNLOAD OR INSTALL. FILE YOUR RETURN ELECTRONICALLY TO
GET YOUR REFUND FASTER. THE EASYSTEPCRJ INTERVIEW ASKS SII1PLE QUESTIONS AND
PLACES YOUR ANSWERS INTO IRS APPROVED FORI1S. THERE IS NO RISK - TRY IT BEFORE
YOU PAY! GET STARTED AT WWW.I1ANDTBANK.COI1/TURBOTAX!
TURBOTAX AND EASYSTEP ARE REGISTERED TRADEMARKS AND TURBOTAX ONLINE IS A SERVICE
MARK OF INTUIT INC.
LOOSA
REV-1510 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
2005-01076
ESTATE OF
Hampton, Richard
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Prudential Annuity Discovery Select; Kelly Greensmith and Toni Rakoski,
beneficiaries. Account No. E0177273. 0.00
This was a Prudential annuity which was a type of life insurance policy that
paid a death benefit.
I
I
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hampton, Richard
FILE NUMBER
2005-01076
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Neill Funeral Home, Inc.
Funeral Luncheon, Elks Lodge, Camp Hill, PA
1,789.80
1,228.50
2.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
3,000.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
3,500.00
Claimant Toni Rakoski
Street Address 416 Parkside Road
City Camp Hill
State PA .Zip 17011
Relationship of Claimant to Decedent Daughter
4.
Probate Fees
360.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
150.00
7.
Publication of Estate Notice in Cumberland Law Journal and Central Penn Business Journal
166.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,194.30
REV-1512 EX+ (12-03) '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Hampton, Richard
FILE NUMBER
2005-01076
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
PA SERS (retirement fund overpayment)
2,530.56
2.
Country Coach Motor Home registration with Commonwealth of Pennsylvania
81.00
3.
Repairs to Country Coach Motor Home in preparation for sale of same
622.63
4.
Classified ad for sale of Country Coach Motor Home
39.95
5.
Insurance for Country Coach Motor Home
1,126.00
6.
Storage of Country Coach Motor Home
1,658.88
7.
Estate checks
24.10
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
6,083.12
REV-1513 EX+ (9-00) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Hampton, Richard
FILE NUMBER
2005-01076
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Kelly Hampton Greensmith, 925 Appenzell Dr., Hummelstown, PA 17036 Daughter 50
2. Toni R. Hampton (Rakoski), 416 Parks ide Dr., Camp Hill, PA 17011 Daughter 50
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DiSTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
I
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
l
J')
..
)
~
Q)
6 .::(
a: ~...o.::(
Q) ...$
.. u- ~..-I
~ -?
-~
\II ~c:r
,...4
~
~
~
ffi
~ ~';S
0::"",
tl:e
~ ct:)
4. <I"
~ ~
4.
~lP ..,.-
cD
e cD
:5 <I"
-;
~ <I" (f)
,~ <I" ~
Lt') s
cf:) 1"-
~ ~
""
.-
!!!
=
Iii
--
~
lIS
Q
'1
~
CD
y.,
~
--
=
~
1
'"
:s
~a
~~
eg
..,,; -el
~~
.%1
~'"
.$ $:>
0$....
~%
~
;;:;.
~i!O"
~ ~ .~rg
21~~~
i~~\\
t:n U- '" 0
~ Ji~'%
~ !!~
.,;
~
0
."
0 !O
0
~
. g
0 c
i Q;
6"'",
.. -00
'" 'roE
" -01'
co
~ "'"
=> V)~
~ "'~
u.JE
~ a;~/
~ u.-Z{
{f-
a:>
<>
.~
a:>
(/) !O
a:> en
1 ~
,,'
0"
"'~
0. ~i
~
~ J}E
--g~
.... '"-"
'"
d"
rn
::T
cr
OJ
,..:\
.Jl
.Jl
::T
::T
::T
\.I1
cO
ii\
1'''
-
-
'-
.0
,\.-
<t
V)
::>
to
rd
......ouu...' uu.u un' __GU 0'''' P..""....~u..."' co" ,.oW""'"U"' ,ow...w..""
\~~
~;;
-~
~1
if
...
~
..
&:
.,;
~
~
o
iJ) -\ ~
~ \ i
~~;; ~ ~
!~l ~
iii \
~ ...
~
~ 8
~ '~
~(/)
c;~
~\.~
>-* .9 u-
~i~ ~
~~ ~ Q.
~~~ ~
\~
-'
rn
s
tr
ru
r-=I
Jl
J1
S
S
S
\.f'l
cO
~
i ~
'"
t! ~
,~ ;;
.i.1>"'-
.~/ ~
~ 3:
.9
"'&
%
\!!
jS
~
a
.e
g.,
.iIl
(:.
! ~
€otf)
tf)
@
0-
~
:2
en
.~t
u->-
;>-~
"'"
0"
M,~
~~
-o~
Q)'~
u-i"
il
,-
!O
"'"
"ai"',,;...
u-~
fu~
OS
"'~
"'~
uJ-g
-00
tf.~
..:
C'
10
en
.e~
u-~
~
"'"
e~
Jig
-o~
"'0
u-"
i}
*~
~ Q;
.~ 6
\0
~
'"
u.J'"
-0-"
~~
r-
,~
'"
~~
3:'"
i
c::Jj~
,....o-o~
i .
c ~
9~~ ~
~ i~l ~
:%0
.
o
~
~
.
~
~
.
~ c
l i'~ ~
~ ~ <;..)0=
.= i52~
~~~~
9-g~J'
~~ii
~
.~
~~
E"
'" ifj';-"<'
~i~
JS. ~3
-0 -g,t;
CET~
~.
:g
g,
!l
e."t:i
g,~
-ll'"
.~i
~ z:~~;; ~ ~
:a !~~-3~ l ~
i g~~~~ ,~g
':2:~;>- ~o
:e Q~ ~
~ ~j ~ ~
8i~! ~J Q
",,0
....
3~3H i33d :J.N3Idl::>3~
o
~
~
"a, *(1)
'" "-
\' 1~~." l
... ~.-.
~
0-
N
\
\
~
Ii>
\
\
\
\
\ a:>
g
a:>
~
CIC
\ ~
\ is
c;;
i
~\ :s
'"
" ~
..:a ~
-0' ~
4:1
N
E
o
u
o
Z
C
~rJ
r:tI ~ ~
l.ff;Q;.:~~..\11
i.~! l
"!'<t ,..
.... L"}.- .
'4
1,0
~
,
\
. \
\
\
\
\\
\e.,
..\;
\~
,p.
\~
"' \~
'~ \0
c",,;:
.~ ~ g
.~:g\ ~
cc 4:\"
"'
co
0
.....
C-
O
e
<~ ~
'"
~, CO
Cl>
Vi
i ~
a:>
,:!:
Q;
0
~ ~
g
Vi CO
.,
...
I ~ .;;;
a:>
CIC
~ ~
~ ....
2 2:
CO
~
~ ~
\\\~
~~
~ ~~
~~\s\
~
~\
--::=
~
- -
- -
~
:::. -
~
- -
- -
~
- -
~
}\:ms jfH;;U it' \\;);,:[j ;j;:lS
G3033N H~f\Od ON
...