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HomeMy WebLinkAbout03-03-08 :.-I 15056051058 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number ~I 05 ,544_ Date of Birth 535-54-5906 09/07/2000 11/23/1947 Decedent's Last Name Suffix Decedent's First Name MI Gordon Patricia S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Gordon Robert w Spouse'sl?o.cial. Sec;urity..Nul11ber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (^.::: 1. Original Return 2. Supplemental Return 4. Limited Estate c::~:) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required (tf 4a. Future Interest Compromise (date of death after 12-12-82) .:::::) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) r::::.::> 10. Spousal Poverty Credit (date of death C:"") 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 Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c~::) Robert W. Gordon Firm Name REGISTER OF USE ONLY First line of address Post Office State DATE FILED 426 Shippensburg Road ZIP Code 17241 Correspondent's e-mail address: DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 ---' ~ ~ 15056052059 REV-1500 EX Decedent's Name: Patricia S Gordon 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) <.::::.J 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. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/Sec.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 .OQ... 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 535-54-5906 0.00 0.00 0.00 0.00 0.00 o. 0.00 0.00 3,853.00 0.00 3,853.00 -3,853.00 0.00 15. 16. 17. 16. -3,853.00 0.00 0.00 c.~ 15056052059 ~ 11 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Patricia S Gordon STREET ADDRESS 426 Shippensburg Road File Number , , DECEDENT'S SOCIAL SECURITY NUMBER 535-54-5906 CITY Newville I STATE PA I ZIP 17241 Tax Payments and Credits: 1, Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C ) (2) 0.00 3. Interest/Penalty if applicable D.lnterest E. Penalty Total Interest/Penalty ( D + 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) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (5B) 0.00 0.00 0.00 0.00 0.00 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. 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;.......................................................................................... 0 [Kl b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [Kl c. retain a reversionary interest; or.......................................................................................................................... 0 IiJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [Kl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................~....................................................................................... 0 [Kl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [Kl - __ _ _ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which - __ _ __ contains a beneficiary designation? ........................................................................................................................ 0 [Kl 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. 39116 (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. 39116 (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 adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 39116(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. 39116(1.2) [72 P.S. 39116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is twelve (12) percent [72 P.S. 39116(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-1~02 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE A REAL ESTATE FILE NUMBER 2005-00544 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 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia ITEM NUMBER 1. SCHEDULE B STOCKS & BONDS FILE NUMBER 2005-00544 All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1.504 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER 2005-00544 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER 1. DESCRIPTION TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 REV-1~05 EX+ (6-9* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF Gordon, Patricia FILE NUMBER 2005-00544 1. Name of Corporation State of Incorporation Address City State_ Zip Code Date of Incorporation Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year 3. Type of Business Product/Service STOCK TYPE Voting/Non-Voting ..rOTALNUMBEROF, . SHARES' OUTSTANDiNG, .' NUMBER OF SHARES OWNED BY THE DECEDENT 4. Common $ $ Preferred Provide all rights and restrictions pretaining to each dass of stock. 5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................. 0 Yes 0 No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . .. 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? o Yes 0 No If yes, 0 Transfer 0 Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....D Yes 0 No If yes, provide a copy of the agreement. 10. Was the "CIecedent's stock sold? .........................,......................... 0 Yes 0 No' If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the de-redent's death? ................... 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, induding dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . .. 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Ust of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those dedared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia ITEM NUMBER NONE SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER 2005-00544 All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 0.00 REV-1~07 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER 2005-00544 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 1 NONE ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 0.00 REV-~508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ITEM NUMBER 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. " DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) FILE NUMBER 2005-00544 VALUE AT DATE OF DEATH 0.00 REV-1,509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 2005-00544 SURVIVING JOINT TENANT(S) NAME If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. RELATIONSHIP TO DECEDENT A. B. C. JOINTLY.OWNED PROPERTY: ADDRESS LETTER ITEM FOR JOINT NUMBER TENANT 1. A. DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) %OF DECO'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 0.00 REV-~510 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 2005-00544 ITEM NUMBE 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 INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. TAXABLE VALUE DATE OF DEATH % OF DECD'S EXCLUSION VALUE OF ASSET INTEREST TOTAL (Also enter on line 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1~11 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Gordon, Patricia FILE NUMBER 2005-00544 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Cemetery Opening Professional Service Death Certificates Minister Services Burial Vault Sunday Burial Charge Casket 335.00 1,940.00 4.00 35.00 769.00 75.00 695.00 2. 3. 4. 5. 6. 7. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) City State Zip Street Address Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City, Relationship of Claimant to Decedent State . Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,853.00 REV-1512 EX< (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & UENS FILE NUMBER 2005-00544 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. TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1~13 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gordon, Patricia NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS Unclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 2005-00544 AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Ir 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 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) REV-1514 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV.1500 Cover Sheet ESTATE OF Gordon, Patricia FILE NUMBER 2005-00544 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will 0 Intervivos Deed of Trust 0 Other o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................................................. Interest table rate - 031/2% 06% 010% 0 Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable . . . . . . . : . ~'o' ~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . . . . . . . . Frequency of payout - 0 Weekly (52) 0 Si-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - 0 3 1/2% 0 6% 0 10% 0 Variable Rate % 6. Adjustment Factor (see instructions) ............................................ . . . . . . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (II more space is needed, insert additional sheets 01 the same size) DEe-IT-200T 01 :2BPM FROM- F CHARLES EGGER, Supervisor ~Y~~Jno. 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 717-776-3414 December 17, 2000 Funeral Bill for Patricia Gordon Date of Death September 7, 2007 Professional Services $1,940.00 Cem~tery Opening $335.00 2 Death Certificates $2.00 a piece $4.00 Minister $35.00 Burial Vault $769.00 Sunday Burial SeIVice Charge $75.00 Casket $695.00 Total $3,853.00 Bill Paid in Full October 2, 2000 T-130 P 002/002 F-368 FRANK C. EGGER, Funeral Director .:.:: . REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No. 2005-00544 PA No. 21-05-0544 Es ta te Of: PA TRICIA S GORDON {First, Middle, Last! Late Of: NORTH NEWTON TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No: 535-54-5906 WHEREAS, on the 16th day of June 2005 an instrument dated July 11th 2000 was admitted to probate as the last will of PA TRICIA S GORDON (First, Middle, Last! la te of NORTH NEWTON TOWNSHIP, CUMBERLAND County, who died on the 7th day of September 2000 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of pennsylvania, hereby certify that I have this day granted Letters of ADMINISTRA TION C. T.A. to: ROBERT W GORDON who has duly qualified as ADMINISTRATOR(RIX) C. T.A. and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANJIL IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 16th day of June 2005. JdbA(L~~e;~~~aA:~w~_ ~OJ'- C\. .r~ . \ ~ Deputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF PATRICIA S. GORDON 1, PATRICIA S. GORDON, of 426 Shippensburg Road, Newville, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do l::1ake, publish and declare this to be my Last Will and Testament. I hereby revoke all previous Wills and Codicils at any time heretofore made by me. ITEM I I order and direct my Executrix, hereinafter named, to pay my debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. ITEM n I have made all of my funeral arrangements with the Frank C. Egger Funeral Home in Newville, Pennsylvania. ITEM m I give, devise and bequeath all of the remainder of my property, of every kind and description - (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will to my husband, ROBERTW. GORDON, ifhe Survives me, orifhe predecea",es me, then to his daughter, PAMEr.A~UE GORDON, ;--~ ':S C,n if she SUrvives me. -2 -----I C:"'>. Page I of 4 ITEM IV Should the gift in Item III fail, for whatever reason, I give, devise and bequeath all the rest, residue and remainder of my estate to JAMES R. GORDON, per stirpes. ITEM V I also have a son, JOHN T. SHINGARA, and a daughter, TIFFANY J. MOGLIA, who were otherwise amply provided for during my lifetime, and are therefore not beneficiaries of my estate. ITEM VI In the event that ROBERfW. GORDON and I should die simultaneously or under circumstances as to render it impossible to determine who predeceased the other, or within thirty (30) days of each other as the result of a common accident, he shall be deemed to have survived me, and all the provisions of this Will shall take effect as though my husband had survived me. ITEM VII I hereby nominate, constitute and appoint PAMELA. SUE GORDON, as Executrix of this my Last Will and Testament. In the event of her renunciation, death, resignation or inability to act for any reason whatsoever, I nominate, constitute and appoint JAMES R. GORDON, as Altemate Executor, of this, my Last Will and Testament. ITEM VIII I hereby direct that no Executor or other Fiduciary named or appointed by this Will shall be required to post any bond or give any security of any type for any purpose whatsoever, nor be liable for failure to file any report. accounting or inventory, in any Page 2 of 4 - . jurisdiction in which he or she may be called upon to act, insofar as I am able by law to do. ITEM IX I hereby authorize my Executrix, in her discretion, to sell, with or without notice, at either public or private sale, and to lease any property belonging to my estate, subject only to such confirmation of Court as may be required by law, for such prices and on such terms and conditions as she deems best, and to make distribution hereunder either in cash or kind, as she may deem wise. I I" ::I:L- day of July, 2000. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~\ . j I .) / Il (l ! 1_ >l---. /,. X I / >7 /t-t/v-t'ut~~~-c.- ~ J/v . 'i:!Af:!'.Lt--"'"'i"'L-L... PATRICIA S. GORDON ~ (.~ J1 i~, .' ' '\ \~)\.r~/'L~~_ " \J)Cup Witness" . y- . l/.J ') ~~~J re. Witness ? /;r'-~,__, residing at QhornbA"~'U 1\, \ ~QL residing at G-.~~A-0 ~-,~j COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, PATRICIA S. GORDON, VICKIE J. GROUP and PATRICIA R. BROWN, Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly swam, do hereby declare to the undersigned Page 3 of 4 . t authority that the Testatrix signed and executed the instrument as her Last Will and Testament, and she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or unduei:nfluence. 0~ A tvg f t / / ,F?t/1 ~~~ L/ ~4Lc- PATRICIA S. GO]:fi)ON - TESTATRIX \J\0.G<:\.lh-x~ Witness ~ ~/~~ ~--0-'_/ Witness Subscribed, sWOm to and acknowledged before me by PATRICIA S. GORDON, the Testatrix:, and subscribed row swom to before Ine by VICKIE J. GROUP and PATRlCIA R. BROWN, witnesses, this / i-ffctay of July, 2000. ~ Q( ! \[' r . V) I . ~~j1\'{~WI tllfCDJ/vtJrkrh \",____ NotaryJ?-rihlic ' ~_._~-- NOTARIAL SEAL DENISE PINAMONTl. Notary Public Carlisle -Sorough._Cumberland County My Commi:~s.!..~('\ Expires Nov. 20, 2000 Page 4 of 4 ~ , 4 3513 NORTH FRONT STREET, HARRISBURG, PENNSYLVANIA 17110 717.234.7828 888.838.3426 717.234.6883 FAX ARZELLA .I. & ASSOCIATES Attorneys & Counselors At Law February 20, 2008 Register of Wills Cumberland County Court House One Court House Square Carlisle, PA 17013 Re: Estate of Patricia S. Gordon Estate No. 2005-00544 To Whom It May Concern: Enclosed please find the Pennsylvania Inheritance Tax Return for the Estate of Patricia S. Gordon and supporting documentation. I have additionally enclosed two copies of the aforementioned return and documents. Please time stamp the extra copy and return it to my office in the postage pre-paid, self-addressed envelope provided. Thank you for all of your assistance. Very truly yours, DCD Enclosure G.,' r....,) c~.) C'" \3D'v'1!)Qd sn ('.J : ~l S 8 f'~ I ,'. "" o~. !~: ex: N E I~: c-. f3 & I~ "C li~. tJ.. t~ ~ CJ Z" I ~3l;'I1H I J.?~.. .... :,i.'~ . ~~~ : :"'':'''.- _~_'1, ...... ... ~". ' :"'-1~'''.}.i: :....