HomeMy WebLinkAbout10-24-06
217
REV- \500 EX (6-0Q)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
OFFICIAL USE ONLY
FilE NUMBER
21-06-0254
COUNTY CODE
YEAR
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Henrv. Richard M.
DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR)
3/13/2006 I 12/17/1928
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
182-22-9579
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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o 1. Original Return 0 2. Supplemental Return
o 4. Limited Estate 04a. Future Interest Compromise (date of death after 12-12-82)
o 6. Decedent Died Testate (Attach copy of Will) 0 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 010. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) 011. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
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Remainder Return (date of death prior to 12-13-82)
Federal Estate Tax Return Required
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Robert G. Frev
FIRM NAME (If Applicable)
Frey & Tilev
TELEPHONE NUMBER
COMPLETE MAILING ADDRESS
5 South Hanover Street
Carlisle, PA 17013
717-243-5838
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) NONE
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE
Of~jC1AL USE ONLY
120,000
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(4) NONE
43,458
7:"-1
(5)
(6) NONE
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6. Jointly Owned Property (Schedule F)
Dseparate Billing Requested
7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property
(Schedule G or L)
(7) NONE
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8. TOTAL GROSS ASSETS (total Lines 1-7)
(8)
163,458
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
6,515
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) NONE
11. TOTAL DEDUCTIONS (total Lines 9 & 10)
(11)
(12)
6,515
156,943
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156,943
12. NET VALUE OF ESTATE (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Scheduie J)
(13)
(14)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate ,or transfers under Sec.9116 (a)(1.2)
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
20.0
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,217
Decedent's Com lete Address:
STREET ADDRESS
110 Sri hton Drive
Henry, Richard M.
182-22-9579
STATE ZIP
PA 17013
(1) 7,062
5,800
290
Total Credits (A + B + C ) (2) 6,090
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty (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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF AGENT
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972
972
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1.
Did decedent make a transfer and:
a. retain the use or income of the 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?
If death occurred after December 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Yes
D
D
D
D
D
D
2.
3.
4.
Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation? .
D
[X]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
[X]
[X]
D
[X]
[X]
[X]
DATE
v.sf 2 '3 loc:lG.
5 South Hanover Street Carlisle PA 17013
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 3%
[72 PS. 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 PS Section 9116 (a)(1.1 )(i1)]
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 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.
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217
REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Henry, Richard M. 21-06-0254
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
110 Brighton Drive, see HUD-1 settlement statement attached
VALUE AT DATE
OF DEATH
120,000
TOTAL (Also enter on line 1, Recaoitulation)
(If more space is needed, insert additional sheets of the same size)
$
120,000
217
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Henry, Richard M.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooertv iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
FILE NUMBER
21-06-0254
ITEM
NUMBER DESCRIPTION
1 Sovereign Bank account no. 2891045203
2 Sovereign Bank account no. 2895282743
3 Accrued interest on above account
4 Sovereign Bank account no. 2895365282
5 Accrued interest on above account
6 1998 Pontiac Firebird, Kelley Blue Book valuation attached
7 Real estate tax proration from HUD-1 settlement statement
8 2004 Pontiac Grand Prix, Kelley Blue Book valuation attached
VALUE AT DATE
OF DEATH
5,069
10,000
15
8,000
14
7,935
1,160
11 ,265
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
43,458
217
REV-1511 EX+(12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
Henry, Richard M. 21-06-0254
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cremation Society 949
2. Patriot News, obituary 231
3. Honorarium 150
4. Flowers 79
5. Book - songs 21
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 1,500
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 306
5. Accountant's Fees included in atty. fee
6. Tax Return Preparer's Fees included in atty. fee
7. Final medical bills 148
8. Expenses of real estate held for sale 2,806
9. Final bills 117
10. Automobile repairs 178
11. Inheritance tax return filing fees 15
12. Notary fees 15
TOTAL (Also enter on line 9 Recapitulation) $ 6515
(If more space is needed, insert additional sheets of the same size)
217
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Henry. Richard M.
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
21-06-0254
AMOUNT OR SHARE
OF ESTATE
1 Richard J. Henry
Son
100%
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
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
$
o
(If more space is needed, insert additional sheets of the same size)
Expenses of Real Estate held for sale
UGI
Waste Management
South Middleton Twp. Munic. Auth.
PPL
Judy Campbell, Tax Collector
State Farm Insurance
Expenses from HUD-1 settlement statement
108
47
99
24
282
206
2040
Total Real Estate Expenses
2806
Medical bills in connection with final illness
Masland Associates
Carlisle Regional Medical Center
15
133
Total medical bills
148
Final Bills
Comcast
T-Mobile
Sprint
T-Mobile
31
25
37
24
Total
117
1. FHA
2. FmHA
3. ConY. Unins.
Settlement Statement - U. S. De artment of Housin and Urban Develo ment Form US HUD . 1
6. Rle Number 7. Loan Number 8. Mortgage Insurance
Case Number
Pa eNo. 1
4. VA RE2751
s. Cony. Ins. ABST#6305 APPUCATION NO. 0606141993
C. This form Is furnished to giye you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside of
the c10sin . th are shown here for informational r ses and are not included In the totals.
D. Name and Address of Borrower:
MICHAELR.DORSHIMER
TERRI L. TOBIN
1136 MOUNTAIN ROAD
NEWBURG, PA 17240
E. Name and Address of Seller:
ESTATE OF RICHARD M. HENRY
RICHARD J. HENRY, EXECUTOR
F. Name and Address of Lender
SOVEREIGN BANK
ISAOA ATIMA
101 S. GEORGE STREET
YORK PA 17401
TIN
G. Property Location
110 BRIGHTON DRIVE, CARUSLE, PENNSYLVANIA 17013
SOUTH MIDDLETON TOWNSHIP
CUMBERLAND COUNTY
PARCEL NO. 40-09-0529-078
H. Buyer's Settlement Agent:
Frey & TIley Law Office
5 South Hanover St.
Carlisle PA 17013
I. Settlement Date:
August 22, 2006
3:30 P.M.
Place of Settlement:
5 South Hanover Street
Carlisle PA 17013
TIN 25-1730538
J. SUMMARY OF BORROWER'S TRANSACTION
K. SUMMARY OF SELLER'S TRANSACTION
100~gN$;'Am~a~~p~~~~.Fil~~ii~~'~~\llii~~~~
101 Contract sales price
102 Personal property
103 Settlement charges from (line 1400)
104
105
400;.~~tm~~IiM~ji:j;jJl~l;~"'~~~"''4
120,000.00 401 Contract Sales price
402 Personal property
4,463.62 403
404
405
120,000.00
Adjustments for items paid by seller in advance;
106 City/town taxes 8/22/06 to 12/31/06
107 County taxes
108 Assessments
109
110 School taxes 8/22/06
111
112
to 6/30/07
Adjustments for items paid by seller in advance;
101.13 406 aty/town taxes 8/22/06 to 12/31/06
407 County taxes
408 Assessments
409
1,058.54 410 School taxes 8/22/06
411
412
101.13
to 6/30/07
1,058.54
120 Gross Amount Due From Borrower
125,623.29 420 Gross Amount Due to Seller
121,159.67
200 '~~6~~p~~id~.::Q~,~'ir~t('Qf~~V;~;~~~~1lf~
201 Deposit or earnest money
202 Prindpal amount of new loan(s)***
203 Existing loan(s) taken subject to
204
205
206
207
208
209
Adjustments for items upaid by seller
210 aty/town taxes 1/1/06
211 County taxes
212 Assessments
213
214 School taxes 7/1/06
215
216
217
218
219
220 Total Paid By/For Borrower
to 8/22/06
soo;R;:;~W~n'tf.t~\I'~;:i~$;fi~~},~r~
501 Excess deposit (see Instructions)
502 Settlement charges to seller (line 1400)
503 Existing Ioan(s) taken subject to
504 Payoff of first mortgage loan
50S Payoff of second mortgage loan
506
507
508
509
Adjustments for items upaid by seller
510 aty/town taxes 111/06 to 8/22/06
511 County taxes
512 Assessments
513
514 School taxes 7/1/06 to 8/22/06
515
516
517
518
519
119,059.00 520 Total Reductions to Amt Due Sell.,
0.00
119,059.00
1,941.16
to 8/22/06
1,941.16
300~~~~t~~:nrf~~1~~~+a.;iWl?:i~i!f:r~1~ 600~~~~~
301 Gross amount due from borrower (line 120) 'i 125,623.29 601 Gross amount to seller from (line 420)
302 Less amounts paid by/for borrower (from line 220) I (119 059.00' 602 Less reductions in amount due seller (from line 520):
303 Cash (X) From ( ) To Borrower 6,564.29 603 Cash ( ) From (X) To Seller
121,159.67
(1 941.16)
119,218.51
-----------
-- - --
-----------
-- ---
HUD-l
L. SETTLEMENT CHARGES
Page No. 2
i~?J1Qi\I!lJill.$.iiles/A.i:'!!k1!ili:~mmI.!:i~:iiij.prr~tL4iih'i!I!l 120,000.00 @ % = 0.00 Paid From Paid From
Division or Commission (line 700) as roi/ows: Borrower's Seller's
701 to Funds at Funds at 701
702 to Settlement Settlement 702
703 703
704 Commission paid at Settlement 704
~ ~
;'''''''~''''''''''~'1'I''''"'''~;".Q'';o;,.,,;rW'''''';'1"'+'~'':'l1!:''''''''f_''''cr;;r~~~...'l'~,wfF~i";lIlN"~'fF"""?""'~"""!:ilm '~li'IIlMl!j,,~~~
:~Q!l:~Jt~.!n$:~iJ.Yjlb.!!!:J;"'~Q"n~!;tiP!tWitti.;l;t)aOG~'Iil1'i~~~M'!i.'t~S~'llc~'llf~~~~:'.!!t5 .~ ~'K"l!\Imlli'i"iil~ooj
(Mortgage Amt: 119,059.00) Total charges, Unes 801 through 811: 357.S0
801 Loan Origination Fee .000 0/0 to 0.00 801
802 Loan Discount .000 0/0 to 0.00 802
803 Appraisal Fee to Diversified Appraisal Services 400 P.O.C. 803
804 Credit Report to CBC Companies 26 P.O.C. 804
80S Lende~s Inspection Fee to 805
806 Mortgage Insurance Application Fee to 806
807 Assumption Fee to 807
808 Flood Certification fee to Sovereign Bank 7.S0 808
809 Underwriting fee to Sovereign Bank 350.00 809
810 810
811 811
r:;~'~~:&;i~~\BYr.;;rdirrT1!1i~~ji~a:.~~"ii~~m;Jls,'~i!~,__ _ ~- liD -- "'filIi ~
901 Interest From 22-Aug-06 to 31-Aug-06 021.08337 per day = 210.83 901
902 Mortgage Insurance Premium for months to Sovereign Bank 1,759.50 902
903 Hazard Insurance Premium for 1 years to P .O.C. 903
904 years to 904
905 90S
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1001 Hazard insurance 3 mos. @ $31.92 per month 9S.76 1001
1002 Mortgage Insurance mos. @ $48.62 per month 0.00 1002
1003 aty property taxes mos. @ per month 1003
1004 County property taxes 7 mos. @ $23.48 per month 164.36 1004
1005 Annual assessments mos. @ per month 1005
1006 mos. @ per month 1006
1007 School taxes 3 mos. @ $103.20 per month 309.60 1007
1008 AgJlre~ate Settlement Adjustme,nt",< ,,,.,,,,,,.,. . = ... '. . . .', ". . ~> (93.99) ". 1008
~ij~I1"~~~~~~i~~~h~;;~~g}:fIl~~~~]j.m~~~~~
1101 Settlement or closing fee to 1101
1102 Abstract or title search to 1102
1103 Title examination to 1103
1104 Titie insurance binder to 1104
110S Document preparation to FREY & TILEY 1105
1106 Notary fees to 1106
1107 Attomey's fees to 1107
(includes above items numbers:
1108 Titie Insurance to FREY &. TILEY (COMMONWEALTH LAND TITlE INS. CO.)
(Indudes above Items numbers: BASIC
1109 Lende~s Coverage $ 119,059
1110 Owners Coverage $ 120,000
1111 CLOSING SERVICE LETIER TO COMMONWEALTH LAND TITLE INSURANCE CO.
700
896.06
1108
Endorsements:
1112
1113 OVERNIGHT DELIVERY FEES TO FREY & TILEY
~~~~luiigiin'h~~am:4"'~'="-"
1201 Recording fees: Deed $39.50 Mortgage: $62.50
1202 atv/county/stamps: Deed $600.00 Mortgage: $
1203 State tax/stamps: Deed $600.00 Mortgage: $
1204 RECORDING FEE TO RECORDER OF DEEDS (EST TO HENRY)
m'b~3tA~:jt1n:em!C~~~'iII-
1301 Survey to
1302 Pest Inspection to
1303 Current Taxes due from Borrower/Seller to Judy A. Campbell, Tax Collector
1304 TAX CERTIFICATION FEE TO JUDY A. CAMPBELL, TAX COLLECTOR
1305 FINAL WATER AND SEWER CHARGES TO SMTMA
35.00
1109
1110
1111
1112
1113
Releases
102.00 1201
600.00 1202
600.00 1203
39.50 1204
27.00 120S
I .j;B ,. .rrm
1301
1302
1,238.36 1303
5.00 1304
58.30 1305
1306
1307
4,463.62 1,941.16 1400
~=--==--==--= =-=----:-====
(SO% EXEMPT)
(50% EXEMPT)
/HUD'1
CERTIFICATION
I direct and authorize the Company to make distributions indicated for my account on the attached HUD-1 Settlement Statement, approving the tax prorations
indicated therein, and understand that prorations were based on figures for the preceding year, or estimates for the current year, and in the event of any change
for the current year, all necessary adjestments must be made between Seller and Borrower direct; likewise any DEFICIT in delinquent taxes will be reimbursed to
Attorney{Title by Seller.
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD.1 Settlement Statement.
~f~
M'.:H~L R. ?ORSH',&,.0/ f
\ ~4(iif~ /
TER L. 08
g/22/ti
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate a
been or will be disbursed by the undersigned as part of the settlement of this transaction.
~
10
August 22, 2006
Date
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include fine and
imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
INFORMATION REPORTING ON REAL ESTATE TRANSACTIONS
THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E, G, H, I, M AND LINE 401) AND IS BEING FURNISHED TO
THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALTY OR OThlER SANCTION WILL BE IMPOSED
ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED.
Solicitation of TIN
Seller is required by law to provide the Attorney/Company with his/her correct taxpayer identification number. If correct taxpayer identification number is not
provided, he/she may be subiect to civil or criminal penalties imposed by law.
Certification of TIN
Under penalties of perjury, I certify that the taxpayer identification number shown in this statement is my correct taxpayer identification number.
Seller
Seller
TAX PRO-RATION ADDENDUM
Parcel No.:
SCHOOL REAL ESTATE TAX
from July 1, 2006 to June 30, 2007
School Real Estate Tax- Face
School Real Estate Tax- Per Day
~- -.--. Wl'. "'
COUNTY & MUNICIPAL TAX
from January 1, 2006 to December 31, 2006
Co. &. Munic. Real Estate Tax- Face
Co. &. Munic. Real Estate Tax. Per Da
---
Date of Pro-Ration:
August 22, 2006
ASSESSMENT:
$113,330.00
See Settlement Sheet
Unes
106 &. 406, 110 &. 410,
210 &. 510, 214 &. 514,
and 1303 for
Results of this Addendum.
School taxes P.O.c. or charged to Seller:
School taxes P.O.C. or charoed to Borrower
Co. &. Munic. P.O.c. or charoed to Seller:
Co. &. Munic. P.O.C. or charoed to Borrower
Q
Sovereign Bank
Richard M Henry
182-22-9579
March 13, 2006
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Account #: 2891045203 Type:
In the name of: Richard M Henry
Date of Death Balance:
Int.(YTD) from 1/1/2006 to
Accrued interest to date of death:
Other Info:
Checking
Open date: 1/6/2003
$5,069.23
3/13/2006
$0.00
$40.53
Account #: 2895282743 Type:
In the name of: Richard M Henry
Date of Death Balance:
Int.(YTD) from 1/1/2006 to
Accrued interest to date of death:
Other Info:
CD
Open date: 2/21/2001
$10,000.00
2/28/2006
$15.15
$54.83
Account #: 2895365282 Type:
In the name of: Richard M Henry
Date of Death Balance:
Int.(YTD) from 1/1/2006 to
Accrued interest to date of death:
Other Info:
CD
Open date: 7/22/2002
$8,000.00
2/28/2006
$13.53
$57.02
Account #: 2895386148 Type:
In the name of: Richard M Henry
Date of Death Balance:
Int.(YTD) from 1/1/2006 to
Accrued interest to date of death:
Other Info: closed 2/16/06 for $9,159.23
CD
Open date: 7/30/1996
$0.00
2/16/2006
$0.00
$41.34
Page 1 of 1
Kelley Blue Book - Private Party Value Pricing Report - Pontiac, Grand Prix
10jl7j2006 0920 AM
KeUey Blue Book
THE TRUSTED RESOURCE
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2004 Pontiac Grand Prix GT Sedan 40
BLUE BOOK PRIVATE PARTY VALUE
Condition
Value
Estimated Payments
$227 jmo @ 7.59% APR
Excellent
$12,030
.t Good
$11,265
Get a Pre-Owned Loan
from 6.65% APR
Your Credit Score for Free
Get a Free Insurance
Quote
(Selected)
Fair
$10,310
Cap;ta.(
Vehicle Details
31,000
V6 3.8 Liter
,ion: Automatic
FWD
No Hassle
Auto Loa ns
Rates as low as
Standard
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Tilt Wheel
Cruise Control
AM/FM Stereo
Single Compact Disc
Dual Front Air Bags
Power Seat
Rear Spoiler
Selected Vechile
$12,030
"Excellent" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has never
had ilny palilt or body wor'k and is free of rust. The vehicle has a clean
title history and will pass a smog and safety inspection. The engine
cornpartment is clean, wittl no fluid leaks and is free of any wear or visible
defe:cts. The: vehicle: also has complete ilnd vel'ifiable: service records. Less
th"n SU/" of "II used veillcles fall IIlto this category.
.t Good (Selected)
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used car
from a private party. The Private Party Value assumes the vehicle is sold "As
Is" and carries no warranty (other than the continuing factory warranty). The
final sale price may vary depending on the vehicle's actual condition and local
market conditions. This value may also be used to derive Fair Market Value for
insurance and vehicle donation purposes.
Vehicle Condition Ratings
Excellent
<!.NoHassle
Used Dealllr from 7.29%
Refinance from 7.45%,
$11,265
"Good" condition means that the vehicle is free of any major defects. This
http:j jwww.kbb.comjKBBjUsedCarsj Printj PricingReport,aspx7QuizCond... 0&5electionHistory= 3 2 7 4%7c 195 8%7c 170 13%7cO%7cO%7c&Condition= Good
Page 1 of 2
Kelley Blue Book - Private Party Value Pricing Report - Pontiac, Grand Prix
10/17/200609:20 AM
vehicle has a clean title history, the paint, body and interior have only
minor (if any) blemishes, and there are no major mechanical problems.
There should be little or no rust on this vehicle. The tires match and have
substantial tread wear left. A "good" vehicle will need some reconditioning
to be sold at retail. Most consumer owned vehicles fall into this category.
Fair
$10,310
'Fair" COndltiOll means that the vehicle has some mechanical or cosmetic
defects and neecls servl~ing but IS still in reasonalJle I"llllning condition.
fhiS vehicle a clean title history, the paint, body and/ol' interior need
work pel'folTilCd by a professional. The ti,'es may need to be replaced.
There may be some repail'able 1'Llst damage,
Poor
NjA
'POOl" condit.ion means that the vehicle has severe mechanical and/or
cosmetic defects and is in poor running condition, The vehicle may have
problems that cannot be readily fixed such as a damaged frame or a
rusted-thl'ough boey, A vehicle with a branded title (salvage, flood, etc.)
or unsubstantiated mileage is conSidered "poor." A vehicle in poor
condition may an independent appl'aisal to determine its value.
Kelley Blue does not attempt to report a value on a "poor" vehicle
because the value of cars in this category varies greatly.
* Pennsylvania 10/17/2006
. SEND TO PI.INTER
http://www.kbb.com/KBB IUsedCars I Pri ntl Prici ngReport.aspx7QuizCond,.. O&5electionH istory= 3 2 7 4%7c 195 8%7 c 170 13%7cO%7cO%7c&Condition =Good
Page 2 of 2
Kelley Blue Book - Private Party Pricing Report - Pontiac, Firebird
06/09/20060913 AM
a Ketley Blue Book
_ THE TRUSTED RESOURCE
.. . kbb.lO.
Close Window X
.
1998 Pontiac Firebird Trans Am Coupe 20
BLUE BOOK PRIVATE PARTY VALUE
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Tilt Wheel
Cruise Control
AM/FM Stereo
Single Compact Disc
Dual Front Air Bags
ABS (4-Wheel)
Leather
Power Seat
Alloy Wheels
Condition Value
Excellent $8,555
../ Good $7,935
(Selected)
Fair $7,160
Vehicle Details
Engine:
Transmission:
Drivetrain:
Mileage:
V8 5.7 Liter
Automatic
RWD
73,000
Selected Standard Equipment
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle is
sold "As Is" and carries no warranty (other than the continuing factory
warranty). The final sale price may vary depending on the vehicle's actual
condition and local market conditions. This value may also be used to
derive Fair Market Value for insurance and vehicle donation purposes.
New Dealer
U~ed Dealer
Refinance
5.89%
7.19",)
7.25~i)
Person-to-Person
8.15"0;
Vehicle Condition Ratings
Motorcyc Ie
8<25U:u
Excellent
~ Apply Now_~.
Capital
I utu IITI. 1 "
$8,555
"Excelient" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has
never. had any pamt or body wor'k and is free of rust. The vehicle has
clean title liistory and will pass a smog and safety inspection. The
enl)inc compartment is clean, with no fluid leaks and is free of any
or visible defects. The vehicle also has complete and verifiable
http://www.kbb.com/kb/ki.dll/kw.kc.ucp7kbb.PA; ; PA041;& 170 13&pop; 870631&;; ucp;&9; PO;C3
Page 1 of 2
Kelley Blue Book - Private Party Pricing Report - Pontiac, Firebird
06/09/20060913 AM
service r'ecol-cJs. Less than
category.
of all used vehicles fall into this
../ Good (Selected)
$7,935
"Good" condition means that the vehicle is free of any major defects.
This vehicle has a clean title history, the paint, body and interior have
only minor (if any) blemishes, and there are no major mechanical
problems. There should be little or no rust on this vehicle. The tires
match and have substantial tread wear left. A "good" vehicle will need
some reconditioning to be sold at retail. Most consumer owned
vehicles fall into this category.
Fair
$7,160
"Fair" condition means that the vehicle has some mechanical or
cosmetic defects and needs ser-vicing but is still in reasonable running
condition. This vehicie has a clean title history, the paint, body and/or
!nteriol- need work per'fonned by a professional. The tires may need to
[)e replaced. There may be some repairable rust damage.
Poor
N/A
"Poor-" condition means that the vehicle has severe mechanical and/or
cosmetic defects and IS In poor r-unning condition. The vehicle may
have pmblems that cannot be readily fixed such as a damaged fr-ame
or a rusted-through body. A vehicle with a branded title (salvage,
flood, ete.) 01- unsubstantiated mileage is considered "poor." A vehicle
In poor condition may r-equire an independent appraisal to determine
ItS value.
* Pennsylvania 06/09/2006
:; I .
httP//www.kbb.com/kb/kLdll/kw.kcucp?kbb.PA;;PA041;&17013&pop;870631&;;ucp;&9;PO;C3 Page 2 of 2
LAST WILL AND TESTAMENT
OF
RICHARD M. HENRY
I, RICHARD M. HENRY widower, of 108 Lawrence Lane, Carlisle,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and
Testament hereby revoking and making void any and all Wills by me at any time
heretofore made.
1. I direct my hereinafter named Executor or Executrices to pay all of my
just debts and funeral expenses as soon after my death as may be found convenient to do
so. I further direct that all inheritance, transfer, succession, estate and death taxes,
including interest and penalties thereon, which may be payable on account of my death
shall be payable from the residue of my estate regardless of whether the assets upon
which such taxes are based are included in my probate estate.
2. I declare that I am an unremarried widower and that I have one (I) child,
RICHARD J. HENRY.
3. All of the rest, residue and remainder of my estate, real, personal and
mixed, and wheresoever the same may be situate, I give, devise and bequeath to my son,
RICHARD J. HENRY. Should my son predecease me, then in such event all of the rest,
residue and remainder of my estate, real, personal and mixed, and wheresoever the same
may be situate, I give, devise and bequeath in equal shares, one share to my son's wife,
MARY PAT HENRY, provided she was married to my son at the time of his death and
unremarried at the time of my death, and one share to each child of my son, the share any
deceased child of my son would have received shall pass to his or her issue, per stirpes,
and if there be no such issue, said share shall lapse and be added to the remaining share
or shares. Should my son's wife, Mary Pat Henry, and all of my son's children and their
issue predecease me, then in such event I give, devise and bequeath all of the rest, residue
and remainder of my estate, real, personal and mixed, and wheresoever the same may be
situate, to the children of MARY PAT HENRY, they being KATIE TOBIN and TERRI
TOBIN.
6. I hereby nominate, constitute and appoint my son RICHARD J. HENRY,
as Executor of this my Last Will and Testament, but should he predecease me or fail to
qualify as such, then in such event I nominate, constitute and appoint my daughter-in-
law, MARY PAT HENRY as Executrix and I further direct that neither of shall be
required to post any bond to secure the faithful performance of his or her duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
my Last Will and Testament written on one (I) page, this IS- tl-, day of SPe>\\:'v,^ \'<21,
2004. l
7~ (SEAL)
~J1J
RICHARD M. ENRY
""
Signed, sealed, published, and declared by RICHARD M. HENRY the Testator
above named, as and for his Last Will and Testament, in our presence, who, in his
presence, at his request, and in the presence of each other, have hereunto subscribed our
names as attesting witnesses.
~-d<~
_0~l~Jl2t~
Page 1 of 1
....
.........
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 007346
HENRY RICHARD J
500 STEElSTOWN RD
NEWVillE, PA 17241
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
__nun fold
101
$972.00
ESTATE INFORMATION: SSN: 182-22-9579
FILE NUMBER: 2106-0254
DECEDENT NAME: HENRY RICHARD M
DA TE OF PAYMENT: 10/24/2006
POSTMARK DATE: 10/24/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 03/13/2006
TOTAL AMOUNT PAID:
$972.00
REMARKS: RICHARD J HENRY
CHECK# 223
SEAL
INITIALS: WZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS