HomeMy WebLinkAbout04-04-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue .
Bureau of Individual Taxes .
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
<:::)
4. Limited Estate
<:::)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
<:::)
2. Supplemental Return
<:::)
<:::)
<:::) 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 Tele hone Number '"'~}
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
J2..
8. Total Number of Safe Deposit Boxes
-
Correspondent's e-mail address:
bt.aM~1'""CS€) ep;;c. ne.t
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN URE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
K ,no ..3~b7-
ADDRESS 1)Elf-tVNA- /If. G/l-rES
Jfltlo'1 S. CLE'M.V'IE"W V~" Q/E(!NANICS8k/e6,/;OA /7DSS"
S :fUR OF P PAR THER THA~SENTATIVE
"
ADDRESS X. €S E'. SIIIEZDS .at.
~ CL.f)"~ IU>.. /7"!f!l!NA7IY/a5/!Jtut6" jJA /7oS-S-
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
---I
.....I
REV-1500 EX
Decedent's Name: R Ie/{ A- ft.!>
RECAPITULATION
15056052048
C.6A-76
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) C) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C) 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.
Decedent's Social Security Number
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 Subjectto 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 .OD-
16. Amount of Line 14 taxable
at lineal rate X.O ff
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE.. . .. . . .. .. . . . .. . .. . . . . .. .. . .. . . . .. . .. .. ..... . .. ., . .. ... . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
C)
L
15056052048
Side 2
15056052048
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
File Number
f(.1 C 1-/ A-tZ..D
--_.__.._-_.._--_._.~.._-------_.- ------_._.,...__._-_...-~-
___It" 01_~.
c . r;/f 7lFS
~Lt:J11( tll IE" kJ_ J)~~__~_____~___ _~___________
-
STREET ADDRESS
II Il.L
----- -----TSTATE ;oA ---------\ ZIP
i
------------------~---------------~-
CITY
e /l-1JI,o
11~/1
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
o
o
-~-,,-"---'--'--"-_.'--------'-
o
-------~.__._--_.._-
__ -- --- ---11--- - -- - ---- -
Total Credits (A + B + C ) (2)
o
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
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.
o
--------~_. ----------','-------- --
______.__ _....J:J_____________ _
(3)
(4)
(5)
(5A)
(5B)
o
4.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
o
o
o
o
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.
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 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~
c. retain a reversionary interest; or.......................................................................................................................... D ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [8j
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................................ ....... ............ ..................................................................... I2Sl 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. 99116(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 P.S. 99116(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.1510ex+(1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
($.A IE S, If Ie f/ II-~ /)
(!.
FilE NUMBER
ITEM
NUMBER
1.
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
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATTACH A COPY OF THE DEED FOR REAL ESTATE,
I teA Ae(!pu/llT A-i H 1l..l../A-ieIJ LY"AlS
J'jEN€FIC/A-/l.y.' DE/f/f/AI/1 /11. 6A-7,E5, .wS
tvl.c€".
SE'G fJlelN/bu T 1//fL.t(A-71~/I/ o/$7/1-/#ED
f7e~111 H / /.,/./IrI2-D L.YCHG .5NIPR///V~ / T€/JJ
/lEV J//ft.tt.o ;hiD o7N'B'l f7~T//J/SV7
(JATA .
DATE OF DEATH
VALUE OF ASSET
"
;}. 2.1 3S7,.j;,
%OF
DECD'S
INTEREST
/ ()()/.
EXCLUSION
IF APPLICABLE)
-0-
TAXABLE VALUE
~
,l,2, tfsz ~"
TOTAL (Also enteron line 7, Recapitulation) $:l:l./ 857. 3.3
(If more space is needed, insert additional sheets of the same size)
4/0712006 01 :01 :58 PM
Account Workbook
Positions
Page: 1
36106439 - GATES RICHARD C
3610-6439
. J236
, HilLIARD l YONS CUST FOR
. RICHARD C GATES IRA
CAPITAL DIRECTIONS
10
CSI
MMF
Home
C
4C
PNP
717/737-6468
Total Acct Val
Funds Available
22.857.33
1.00
MMF Sal
1.00
1 '
--I
2,
3-1
4'
5\
6-!
71
8
9]
101
11
Cl':lantity -t -- __u__~al11~_ - !_Sy_m~oll" CUSIP -j M!<~_Pr!c:!ll_ - V~~u.!.__LI},~f! L..!:~c:_LI'tII911 -,
-- 556_45~06-i--BL;~~~-K MANAGED INCPORT !PMISX ! -091928-76-5! 9:8900 l ~~~g;~~t 1 - -- --; SKF-- ~ Yes - _oj
19r298o.Q~U3~(:;~ROtt<LQ\/\IDURtt-J P()RT - . CMGBX -j 091928-27-51- 9_8400 -! -- 1~882.3Yj 1 -- -- -r SKF- --:-Yes --- i
1.0?.-4.90g0g _iE!l!\GKROCK FDS M()NEY MKT - - '~~~~1 - -g~l~~~=~=g 1- -1~~~~1----.1.~~:~~-;~~-~--= ~:~~-~=~~~:}-------:I
~~:~~~ggl~~x~e~~~~~Jl[P J'~\~YG-- - ! FMCAX ---1----- --3158d5-40~8 -r--- -26.2406:--- -524:25-lr--T~fKr=--TYes---:
- s:09866"l"Flb-ELT'rvH\lAl"sfRAn'----------t-FASJ5X---t- 315918~30-::oT--31~126b :-- - --256:8~1---iSKi=--rYes-l
10_73i60-'-FII5Abv SERf SM CAPT---------- -1-FscfX----i--- - 31580-S:.66:3r-2~D5205r-----253:6T-Lf-----TSKFiYes-----1
139.24600h;WfFn=UNb-AMEFnt,fCcCF------ - -I GFAF)C -j---399874-40:3-1------32."5966-i-----4.53EUi3j.1-- ...-i-SKi=-- - tYes--- -1
120A626011NVESTMENf COAMER CL F -.. -- TAiCFX---T-4613b8-40:5+- --- 32:9-1 ClO-!----n-:Uj64.-45n----- --!- sKr=--1Yes-- ---1
17.93006\ OPPENHMFfaSTCAP VALA-.- ----!o.CVAX- 168381A-10~3T -28:2200 1-----S05.98T1---ulsKF-- Tyes----\
282.9150(ntE.t0~-~EfN Fb_~EIGN FD_9L A -~1 TEMFX - -I 88019~2_d-9 r - 1::p400r~u3:8_8f?~tf~~~-_~I:[Kf.:.::JYe~=
:E
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~ -?::
l:T,4-I'~
A!/C*'"heL)
ITEM
NUMBER
A.
FUNERAL EXPENSES:
1.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
c.
FILE NUMBER
Debts of decedent must be reported on Schedule 1.
DESCRIPTION
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Dt:/ftfIAlII AI. GIt ~
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
2.
Attorney Fees
el/MlES
State _ Zip
e.
SrN/ EZ-J)S
711
-
!e:s hm.)
Claimant
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
A!{)IfJE -/10 S/.lV6L.E ~/!7HE As$E7f
Street Address
City
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Fitl'n; ,f 7~ l?eJuNI.
State _ Zip
AMOUNT
UJ,4-/ V e-t:>
r:
3 sv... &0
~, .s;-, 1$0
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 9, Recapitulation) $ 36 So' tJ-()
REV"1513 EX+ (9-00)
, *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF ,-4 /J' JLI? 1'1 /1
<:::sA res.. ,</t!#~ L..
FILE NUMBER
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec, 9116 (a) (1.2)]
1. IJEAIv'/IIA /11. GATes WI F €
#607 5. e,t..EA-Je~/EW d)/ClrE
(!~4f~ H/Lt.",:7/1 /7~11
AMOUNT OR SHARE
OF ESTATE
/tJO ~
(~EE T ;eUG AtVIJ Cf;MEC7 Cb/!/riJIf!AtElJ
orrlCl; ~P'l Dr LP/U IJ-rrA-C!I{I;!).
7/lD!E tf//fS ~ A!Elft) 7b d?rEn. 7J.IG"
WJL.~ ~/l.. PhS/fTF)
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
LAST WILL AND TESTAMENT OF RICHARD C. GATES
I, RICHARD C. GATES, currently of 4607 South Clearview Drive, Camp Hill, Hampden
Township, Cumberland County, Pennsylvania 17011, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and
making void any and all prior Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as the
same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, is to be distributed to my beloved wife, DEANNA M. GATES, currently of
Hampden Township, Cumberland County, Pennsylvania.
In the event, however, that my said wife should predecease me, or should die at about the
same time as I die, such as in a disaster common to both of us, I give, devise and bequeath my said
Estate in two (2) equal shares between my daughter LISA M. SWARTZ, per stirpes; and my son
ERIC R. GATES, per stirves;
3.
I nominate, constitute and appoint my wife, DEANNA M. GATES, to be the Executrix of
this my Last Will and Testament. In the event that she is unable or unwilling to act as Executrix,
I appoint my daughter, LISA M. SWARTZ to be the Executrix in her place and stead. If my
daughter is unable or unwilling to act as Executrix then I appoint my son ERIC R. GATES to be
the Executor in her place and stead. I further direct that they shall not be required to file bond or
other security in the Office ofthe Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 9Ih day of
~ ' A.D. 2003.
(SEAL)
Signed, sealed, published and declared by the above-named RICHARD C. GATES, as and
for his Last Will and Testament, in the presence of us, who at his request and in his presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
~/ a/arks E7 S/;;'da{; 7j)
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