HomeMy WebLinkAbout05-10-111505610140
REV-1500 EX (°'_'°'
OFFICIAL USE ONLI(
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 1 1 0 2 4 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 4 1 2 2 9 1 3 0 2 1 3 2 0 1 1 1 0 1 0 1 9 2 2
Decedent's Last Name Suffix Decedent's First Name MI
G A T E S J R C A R L N
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE VI/ITH THE
REGISTER OF WILLS
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 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. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
L I N U S E- F E N I C L E 7 1 7 7 E~ 3 1 3 8 3
REGISTE~F WILLS USE-ONLY
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First line of address ' `~ ~~
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2 3 3 1 M A R K E T S T R E E T ~~ ~' -~ - .
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Second line of address -
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DaAT`E~ FILED
City or Post Office State ZIP Code ! _ r,_. _________
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C A M P H I L L P A 1 7 0 1 1
Correspondent's a-mail address: LFENICLEn1REAGERADLERPC • COM
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 prepare~r has any knowledge.
SIGNATURE OF PERSON RE PONSIBLE FOR FILING RETURN DATE
L.-Ci~-rO .~!J ~~~c.,Cil_.,-sue ~i ~.S v.~ ,.- .~ , _ I i ,
ADDRESS ~~ ,
1001 RUPLEY ROAD, APT - 105 CAMP HILL P~- 17011
SIGNATU~ F~PREPARE HEF3rIhFAiV REP SENTATIVE ,DATE
ADDRE S ~ //
2331 MARKET STREET CAMP HILL PA. 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 15056101L10 J
J
1505610240
REV-1500 EX Decedent's Social Security Number
1 8 4 1 i? 2 9 1 3
Decedent's Name: CARL N • GATES , J R -
REC APITULATION
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 and Notes Receivable (Schedule D) .......................... 4.
6 3 5 0 3. 6 4
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
0. 0 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
^ Separate Billing Requested .......
7.
(Schedule G)
8 6 3 5 0 3. 6 4
8. Total Gross Assets (total Lines 1 through 7) ............... .
9 8 5 9 1. 5 0
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .
10.
1 2 3 2
4.
5 3
11 2 0 9 1 6. 0 3
11. Total Deductions (total Lines 9 and 10) ..............................
.
.
12 4 2 5 8 7. 6 1
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 (Schedule J) ..................... 13.
.
14.
..
Net Value Subject to Tax (Line 12 minus Line 13)
...........
...
...
...14.
4 2 5 8?.
6
1
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 0 0 0 15• 0. 0 0
(a)(1.2) X .0
16. Amount of Line 14 taxable 0 0 0 16 0 ' 0 0
at lineal rate X .0 .
17. Amount of Line 14 taxable 1 4 1 9 5 8 7 17. 1 7 0 3. 5 0
at sibling rate X .12
18. Amount of Line 14 taxable 2 8 3 9 1 7 4 18. 4 2 5 8. 7 6
at collateral rate X .15
19.
19. TAX DUE ..................................................... .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L 1505610240
Side 2
5 9 6 2. 2 6
0
1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 0247
DECEDENT'S NAME
CARL N• GATES, JR•
STREET ADDRESS
100 MOUNT ALLEN DRIVE
CITY
MECHANICSBURG
STATE
PA
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments 5 , 6 6 4 •16
B. Discount 2 9 8.10
3. Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
5,962.26
Total Credits (A + B) (2) 5 , 9 6 2.2 6
(3)
(4) 0.0 0
(5) 0.0 0
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 : ............................................................. ......... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ...................... ......... ^ Q
c. retain a reversionary interest; or ....................................................................................... ......... ^ ^X
d. receive the promise for life of either payments, benefits or care? .............................................. ......... ^ Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................. ......... ^ Q
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ......................................................................................... ......... ^ 0
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (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 21 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 percent [72 P.S. §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 percent, excE;pt as noted in
72 P.S. §9116(1.2) [72 P.S. §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 percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESIDENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
CARL N• GATES, JR• 21 11 0247
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 1995 BUICK RIVIERA 1,000.00
2• PERSONAL PROPERTY 500.00
3• M & T BANK - CHECKING ACCOUNT - #9838438365 17,540.22
499 MITCHELL ROAD
MILLSBORO, DE 19966
4• M & T BANK - SAVINGS ACCOUNT - #15004211803611 42,999.62
499 MITCHELL ROAD
MILLSBORO, DE 19966
5• CUMBERLAND COUNTY VET• DEATH BENEFIT 100.00
6• MEDICARE PART D COVERAGE GAP REBATE/REFUND 250.00
7• CAPITAL BLUE CROSS REFUND 153.80
8• 2011 TAX REFUND 960.00
TOTAL (Also enter on line 5, Recapitulation) I $ 6 3 , 5 0 3.6 4
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
CARL N• GATES, JR• 21 11 0247
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME & CREMATORY, INC• 3,955.00
2• MEMORIAL SERVICE 533.00
3• DINNER/RECEPTION -MEMORIAL SERVICE 467.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2, AttomeyFees: REALER & ADLER, PC 3,000.00
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: CUMBERLAND COUNTY REGISTER OF WILLS 206.50
5 Accountant Fees: ROBERT W • MORRIS - PREPARE 2010 TAX RETURNS 175.00
6. Tax Return Preparer Fees:
7. FILING INHERITANCE TAX RETURN AND INVENTORY 30.00
8• LEGAL ADVERTISEMENT - CUMBERLAND LAW JOURNAL 75.00
9• LEGAL ADVERTISEMENT - CENTRAL PENN BUSINESS JOURNAL 150.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 8 , 5 91.5 0
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CARL N• GATES, JR• 21 11 0247
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NURSING HOME- MESSIAH VILLAGE 12,016.54
2• PHARMACY - ALERT PHARMACY SERV• INC• 307.99
TOTAL (Also enter on Line 10, Recapitulation;i l $ 12 , 3 2 4 •5 3
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
CARL N • GATES, JR • 21 11 Oi?4?
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. RICHARD L• MURRAY - NEPHEW Collateral 28,391.74
5460 RIVENDALE BLVD•
MECHANICSBURG, PA 17050
2• ARLENE MURRAY - SISTER Sibling 14,195.87
1001 RUPLEY ROAD, APT• 105
CAMP HILL, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
n rn~re space is neeaea, use addltlonal sheets of paper of the same size.
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LAST WILL AND TESTAMENT -' Z} ~ `"~ ~I'
OF
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CARL N . GATES , JR . ~~
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I, Ca rl N. Gates, Jr. , of 224 Four Seasor.~s Lane, Enola,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this to be
~my Last Wi~_1 and Testament, hereby revoking all Wills and Co dicils
heretofore made by me.
I ITEM I. I direct that all my debts and fur.~eral expenses,
including my cemetery lot and grave marker and all ex ense
p s of my
last illness, shall be paid from my residuary estate as soon as
';practicable after my death as part of the expense of the
administration of my estate.
.~
~..
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ITEM II. I devise and bequeath all of my estate of every
nature and wherever situate as follows:
A. Two-thirds (2/s) to Mary F. Schumacher
B. One-third ('/s) to Arlene Murray
ITEM III. Should Mary F. Schumacher or Arlene Murray predecease
me or die on or before the thirtieth day following my death, then
in that case, her share of my estate shall pass to my nephew,
Richard Murray.
ITEM IV. I direct that any and all Inheritan::e, Estate and
Transfer taxes imposed upon my estate passing under my Will or
otherwise, shall be paid out of the principal of my z~e.sidual estate.
ITEM V. I appoint, Mary F. Schumacher, 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 appoint
Arlene Murray, Executrix of this my Last Will and Testament. I
relieve my Executrix from the necessity of posting security in
connection with her duties as such in any jurisdiction in which she
may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last
w,_,
Will and Testament, which consists of ~ pages, to each of which
I have affixed my signature this ~~~~ ~ da of ~`
Y ~y_~C°. t w o
thousand five (2005) .
~~
~. ~~.
Carl N. Gates, Jr'.
COMMONWEALTH OF PENNSYLVANIA
ss .:
COUNTY OF PERRY
We, Carl N. Gates, Jr. , and ~.-~" :: ~ •`~ '
i ~~ ~,. ti- ~ ~ ~ r f ~ Y ~. ~c:t.c • ~ ~ ~ ~ a n d
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~;
~ -`~,~' E~ ~~. ~ ~ ~ 3'• ~~-~6 ~~~~~•,-` the testator and t:]~e witnesses
:~ res ectivel t'
p y, whose names are signed to the attachf=cl or foregoing
'instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testator signed an.c~ executed the
p in strurment s s s tha _ '_
I a hi La t Wi 11 anc~ t he haC ~- i gnP:~ ~~,r, 11 ingl_ 1j , ??-, d
jthat he executed it as his free and voluntary act for the purposes
E
therein expressed, and that each of the witnesses, in the presence
a
and hearing of the testator, signed the Will as witness and that to
the best of their knowledge the testator was at that time ei hteen
g
years of age or older, of sound mind and under nc> constraint or
undue influence.
Carl N . Gates , Jr' . , estator
T `^ :` ~ f
~1i tnes~
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Witness '~~
"Subscribed and sworn to and acknowledged
before me by Carl N. Gates, Jr., Testator
;and subscribed and sworn to and acknowledged
,r
before me by ~;~, ~~~. ~'ti ~~ ~ ,~>~~ •t; ;., ,~ ,- '~, , _. and
i _ r:~~-;,°, ~' E `• ti"fir,: ~
ti ~ ~' witnesses this
~~.,~~~. day of ~ ~ `
•~-; ~ ~ ~~ ~t {1
`Notary Public
I NC~6gRU1L SEAL
lf~i6}I Mll+t SNVDER
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~Y ~~
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S~ OOROtI~iH.PERR11 COU~IIY
', Mhl Com1M~Ik'm Nby ; 4, 2004
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