HomeMy WebLinkAbout07-29-14 � 1505611184
REV-1500 EX(02-11)(FI) .��
enns lvania OFFICIAL USE ONLY
PA Department of Revenue PEVqq,�E Y County Code Year File Number
Bureau of Individual Taxes pINHERITANCE TAX RETURN `
PO BOX 280601
Harrisburg PA1�1z8-o6oi RESIDENT DECEDENT �I 13 (�� I
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
03162013 02241914
DecedenYs Last Name Suffix DecedenYs First Name MI
GATES � MARTHA � �
(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
Q 1.Original Return Q 2.Supplemental Return � 3. Remainder Return(date of death
prior to 12-13-82)
Q 4. Limited Estate Q 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
Q 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
ROBERT GATES 717-697-1477
REGISTER OF WILLS USE ONLY
hD
�"� :7.a r� ..
First line of address -��'-� "' -• ��
'�.-7 � r;` ,- 7
L''-7`r,,' �� t•-��
412 CASCADE ROAD -�*'`-j f=�-' � {-
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Second line of address �-��'�'�`_:'-? w �_' :-�i
��M`_` r..: `._,
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City or Post Office State ZIP Code �iE Fi�E� � ;.�, ;=�
�_.. .. �— � .
MECHANICSBURG PA 17055 � �'" ��T�'
c_.
Correspondent's e-mail address:
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. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSO RES O LI RETURN - DATE
1 - l
ADDRESS
412 CASCADE ROAD, MECHANICSBURG, PA 17055
SIG TURE PREP RER OTHER THAN REPRESENTATIVE DATE
• �`-- 7/17/2014
DD SS
415 FALLOWFIELD ROAD, CAMP HILL, PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505611184 1505611184 �
� 1505611284
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedent's Name:MARTHA M GATE S
RECAPITULATION
1. Real Estate(Schedule A). .. . .. . .. .. ..... .. . .. ..... .. .... .. ..... . .. . . . 1. •
2. Stocks and Bonds(Schedule B) .. .. . .. . . . .. .. .. . . .. .. ... .. . .. . .. .. . . . . 2. 19 5, 24 5•6 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. •
4. Mortgages and Notes Receivable(Schedule D) . .. .. . . . .. .. .. .. . .. .. .. . . . . 4. 12 9•7 8
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. . . 5. 2 2 , 9 31. 9 7
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. .. . 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... .. .. . 7. .
8. Total Gross Assets(total Lines 1 through 7). . .. .. . . . .. .. .. . .. .. .. .. . .. .. 8. 218, 3 0 7•3 5
9. Funeral Expenses and Administrative Costs(Schedule H). . . .. . .. .. .. .. . . . .. 9. 18, 9 3 8 •4 7
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . .. .. .. . . . . .. . 10. 3 4 0•0 0
11. Total Deductions(total Lines 9 and 10). . . .. . . . . . .. . .. . .. ... .. . .. . . . . .. . 11. 19, 2 7 8 •4 7
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . .. .. .. .. .. . .. .. . . . . . .. . 12. 19 9, 0 2 8 •8 8
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . .. .. .. .. .. . .. ... . . . . .. . 13. 1, 0 0 0• 0 0
14. Net Value Subject to Tax(Line 12 minus Line 13) . .. .. .. . .. .. .. ... .. .. .. . 14. 19 8 , 0 2 8.8 8
TAX CALCULATION-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_ . 15. .
16. Amount of Line 14 taxable
atlinealrate X.045 198, 028• 16. 8, 911.26
17. Amount of Line 14 taxable
at sibling rate X.12 . 17. •
18. Amount of Line 14 taxable
at collateral rate X.15 • 18. •
19. TAX DUE . .. .. . .. .. ... .. . ... .. .. . . .. .. .. .. .. .. .. ... .. .. .. .. .. .. . .. 19. 8, 911.2 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505611284 1505611284 �
REV-1500 EX(FI) Page 3 File Number 21-13-0 6 O l
Decedent's Complete Address:
DECEDENT'S NAME
MARTHA M GATES
STREET ADDRESS
325 WESLEY DRIVE APT 3104
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) ��) 8, 911.2 6
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+g) (2) 0.0 0
3. Interest
(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. (5) 8, 911.2 6
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:.......................................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income:........................................ .... ❑ �
c. retain a reversionary interest .......................................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ ❑X
4. Did decedent own an individual retirement account,annuity or other non-probate properry,which
contains a beneficiary designation? ........................................................................................................................ ❑ ❑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.
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 surviv ing 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 requir ements 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 deceasetl 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 decedenYs lineal beneficianes is 4.5 percent,exc ept as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a) (1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decetlent,whether by blood or adoption.
REV-1502 EX+ (12-12)
� pennsylvania SCHEDULE A
�� DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN R EAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARTHA M GATES 21-13-0601
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 pr�perty that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1.
TOTAL(Also enter on Line 1, Recapitulation.) $
If more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(8-12)
� pennsylvania SCHEDULE B
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. UNITED STATES SAVINGS BOND - SERIES I - M005907540I 1, 000.00
2. UNITED STATES SAVINGS BOND - SERIES I - M005907543I 1, 000.00
3. LTNITED STATES SAVINGS BOND - SERIES I - M005907542I 1, 000.00
4. LTNITED STATES SAVINGS BOND - SERIES I - M005907541I 1, 000.00
5. UNITED STATES SAVINGS BOND - SERIES I - X001359835I 10, 000.00
6. UNITED STATES SAVINGS BOND - SERIES I - X001359834I 10, 000.00
7. L7NITED STATES SAVINGS BOND - SERIES EE - M71925041EE 1, 968.40
8. LTNITED STATES SAVINGS BOND - SERIES EE - M71925040EE 1, 968.40
9. UNITED STATES SAVINGS BOND - SERIES EE - X4501702EE 10, 828.00
10. UNITED STATES SAVINGS BOND - SERIES EE - M17855297EE 1, 968.40
11. LTNITED STATES SAVINGS BOND - SERIES I - M003711892I 1, 000.00
12 . UNITED STATES SAVINGS BOND - SERIES I - D002544962I 500.00
13 . UNITED STATES SAVINGS BOND - SERIES I - D002544961I 500.00
14. UNITED STATES SAVINGS BOND - SERIES I - M003711890I 1, 000.00
15. UNITED STATES SAVINGS BOND - SERIES I - D002544963I 500.00
16. UNITED STATES SAVINGS BOND - SERIES I - D002544964I 500.00
17. UNITED STATES SAVINGS BOND - SERIES I - M003711893I 1, 000.00
18. UNITED STATES SAVINGS BOND - SERIES I - M003711891I 1, 000.00
19. UNITED STATES SAVINGS BOND - SERIES I - V002151707I 5, 000.00
20. UNITED STATES SAVINGS BOND - SERIES I - V002151706I 5, 000.00
21. UNITED STATES SAVINGS BOND - SERIES I - V002151705I 5, 000.00
22. UNITED STATES SAVINGS BOND - SERIES I - V002151704I 5, 000.00
23 . UNITED STATES SAVINGS BOND - SERIES EE - X2177814EE 14,236.00
24. UNITED STATES SAVINGS BOND - SERIES EE - X2243212EE 13, 956.00
25. UNITED STATES SAVINGS BOND - SERIES EE - X4556827EE 10, 828.00
26. UNITED STATES SAVINGS BOND - SERIES EE - M17855295EE 1, 968.40
27. UNITED STATES SAVINGS BOND - SERIES EE - X2177815EE 14,236.00
28. UNITED STATES SAVINGS BOND - SERIES EE - X2177813EE 14,236.00
29. UNITED STATES SAVINGS BOND - SERIES EE - M17855296EE 1, 968.40
30. LTNITED STATES SAVINGS BOND - SERIES EE - M17855298EE 1, 968.40
31. UNITED STATES SAVINGS BOND - SERIES EE - M17855299EE 1, 968.40
32. UNITED STATES SAVINGS BOND - SERIES EE - M17855300EE 1, 968.40
33. UNITED STATES SAVINGS BOND - SERIES EE - M17855301EE 1, 968.40
34. UNITED STATES SAVINGS BOND - SERIES EE - M17855302EE 1, 968.40
35. UNITED STATES SAVINGS BOND - SERIES EE - M17855303EE 1, 968.40
36. UNITED STATES SAVINGS BOND - SERIES EE - M17855304EE 1, 968.40
37. UNITED STATES SAVINGS BOND - SERIES EE - M17855305EE 1, 968.40
38. UNITED STATES SAVINGS BOND - SERIES EE - M17855306EE 1, 968.40
39. UNITED STATES SAVINGS BOND - SERIES EE - M17855307EE 1, 968.40
40. UNITED STATES SAVINGS BOND - SERIES EE - M17855308EE 1, 968.40
FROM CONTINUATION SCHEDULE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,431.20
TOTAL(Also enter on line 2,Recapitulation) $ 19 5,2 4 5.6 0
If more space is needed,insert additional sheets of the same size
REV-15o4 EX+(g-i2)
SCNEDULE C
�pennsylvania CLOSELY-HELD CORPORATION,
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN PARTNERSHIP OR
RESIDENT DECEDENT SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL(Also enter on line 3, Recapitulation) $
(If more space is needed,insert additional sheets of the same size)
REV-1505 EX+ (11-11)
� pennsylvania SCHEDULE C-1
�� DEPARTMENT OF FEVENUE CLOSELY-HELD CORPORATE
INHERITANCE TAX RETURN STOCK INFORMATION REPORT
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
1. Name of Corporation State of Incorporation
Address Date of Incorporation
City State ZIP Code Total Number of Shareholders
2. Federal Employer ID Number Business Reporting Year
3. Type of Business ProducUService
4• TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK VotinglNon-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No
If yes, provide amount of indebtedness$
7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . ❑Yes ❑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?
❑Yes ❑No If yes, ❑Transfer ❑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 decedenYs death? . .. . ❑Yes ❑No
If yes, provide a copy of the agreement.
10.Was the decedent's stock sold? . . . . ... . .. . . . ... .. . ... . . . ... . .. . . . . . . ... . . . ... ... .... ❑Yes ❑No
If yes,provide a copy of the agreement of sale,etc.
11. Was the corporation dissolved or liquidated after the decedenYs death? .. .. . . . .... . . . . . . . . . ❑Yes ❑No
If yes,provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . ❑Yes ❑No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
� • •- • � �
A. Detailed calculations used in the valuation of the decedenYs stodc.
B. Complete copies of financial statements or federal corporate income tax returns(Form 1120)for the year of death and four 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. List of principal stockholders at the date of death, number of shares held and their relationships 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 declared 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-1506 EX+(12-11)
� pennsylvania SCHEDULE C-2
r DEPARTMENT OF REVENUE PARTNERSHIP
INHERITANCE TAX RETURN INFORMATION REPORT
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
1. Name of Partnership Date Business Commenced
Address Business Reporting Year
City State ZIP Code
2. Federal Employer ID Number
3. Type of Business ProducUService
4. Decedent was a ❑General ❑Limited partner. If decedent was a limited partner, provide initial investment$
5• PARTNER NAME PERCENT PERCENT BALANCE OF
OF INCOME OF OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedenYs interest$
7. Was the partnership indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No
If yes, provide amount of indebtedness$
8. Was there life insurance payable to the partnership upon the death of the decedent? .. .. .. ❑Yes ❑No
If yes, Cash Surrender Value$ Net proceeds payable$
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
❑Yes ❑No If yes, ❑Transfer ❑Sale Percentage transferred/sold
Transferee or Purchaser Consideration$ Date
Attach a separate sheet for additional transfers and/or sales.
10.Was there a written partnership agreement in effect at the time of the decedenYs death? . . .. . . ❑Yes ❑No
If yes, provide a copy of the agreement.
11. Was the decedenYs partnership interest sold? . . . . . . . .. . . . . .. .. .. . . . .. . ... ... . . . . . . .... ❑Yes ❑No
If yes,provide a copy of the agreement of sale,etc.
12.Was the partnership dissolved or liquidated after the decedenYs death? . .. . . . . . ... . . . .. .. .. ❑Yes ❑No
If yes,provide a breakdown of distributions received by the estate, including dates and amounts received.
13.Was the decedent related to any of the partners? .. .... .. ...... ............. ...... ... .. ❑Yes ❑No
If yes, explain
14.Did the partnership have an interest in other corporations or partnerships? ....... ... ..... ❑Yes ❑No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
• • • � • � �
A. Detailed calculations used in the valuation of the decedenYs partnership interest.
B. Complete copies of financial statements or federal partnership income tax returns(Form 1065)for the year of death and four preceding years.
C. If the partnership 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. Any other information relating to the valuation of the decedenYs partnership interest.
_ _
REV-1507 EX+ (04-13)
� pennsylvania SCHEDULE D
riT DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGES & NOTES
RESIDENT DECEDENT RECEIVABLE
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
l. NATIONWIDE INSURANCE REFUND DUE 51.00
2. ASBURY COMMUNITIES INC. RETURN REFUND DUE 58.68
3 . REMINISCE MAGAZINE REFUND DUE 20.00
4. PNC BANK - INTEREST DUE .10
TOTAL(Also enter on line 4,Recapitulation) $ 12 9.7 8
(if more space is needed,insert additional sheets of the same size)
_ _ _ _
REV-1508 EX+(08-12)
� pennsylvania SCNEDULE E
; DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC•
INHERITANCE TAX RETURN � PERSONAL PROPER�
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARTHA M GATES 21-13-0601
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. PNC CHECKING ACCOUNT #50-7007-2635 19, 991.27
2• PNC CHECKING ACCOUNT #108008134 1, 889.65
3. HOUSEHOLD FURNISHINGS & CLOTHING 1, 000.00
4 . CASH 51.05
TOTAL(Also enter on Line 5, Recapitulation) $ 22 931.97
If more space is needed, use additional sheets of paper of the same size.
REV-15og EX+(oi-io)
� pennsylvania SCNEDULE F
��� DEPARTMENTOFREVENUE )OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARTHA M GATES 21-13-0601
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.
B.
C.
]OINTLY 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 DECEDENT'S VALUE OF
NUMBER TENANT lOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
TOTAL(Also enter on Line 6, Recapitulation) $
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
�� pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
ITEM iNCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND
NUMBER THE DATE OF TRANSFER. ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1.
TOTAL(Also enter on Line 7, Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
_ _ _
REV-1511 EX+ (08-13)
�� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' MYERS BUHRIG FUNERAL HOME 16, 515.00
2. MISCELLANEOUS FUNERAL EXPENSES 1, 004.27
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City _ State ZIP_ ___
Year(s)Commission Paid: _._ ___ _. _
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Adtlress
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 3 1 3.5 0
5. Accountant Fees: 750.00
6. Tax Return Preparer Fees:
7. LETTERS OF TESTAMENTARY 253.92
8. POSTAGE 101.78
TOTAL(Also enter on Line 9, Recapitulation) $ 1s, 938.47
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+ (12-12)
� pennsylvania SCHEDULE I
: DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
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, MEDICAL EXPENSES OF DECEDENT 340.0
TOTAL(Also enter on Line 10, Recapitulation) $ 340.00
If more space is needed, insert atlditional sheets of the same size.
REV-1513 EX+(01-10)
� pennsylvania SCHEDULE )
- DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARTHA M GATES 21-13-0601
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 distributi�ns and transfers under
Sec. 9116 (a) (1.2).]
1. NANCY BENSON DAUGHTER 25%
126 COUNTRY WALK ROAD
SCHENECTADY, NY 12306
2. MAJORIE BOWERS DAUGHTER 25%
168 FLORENCE DRIVE
HARRISBURG, PA 17112
3. DENIS GATES SON 25%
887 FIREPLACE ROAD
EAST HAMPTON, NY 11937
4. ROBERT GATES SON 25°s
412 CASCADE ROAD
MECHANICSBURG, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. Bethany Village Care Assurance Endowment Fund 1, 000
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 1, 000.00
If more space is needed, use additional sheets of paper of the same size.
REV-1514 EX+(4-09)
� pennsylvania SCHEDULE K
. DEPARTMENT OF REVENUE LIFE ESTATE, ANNUITY
BureauoflndividualTaxes &TERM CERTAIN
PO Box28o6o�
Harrisburg PA i�128-o6oi (CHECK BOX 4 ON REV-1500 COVER SHEET)
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
This schedule should 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.
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 below the type of instrument that created the future interest and attach a copy of it to the tax return.
❑ Wi11 ❑ Intervivos Deed of Trust ❑ Other
•
NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑Life or ❑Term of Years
1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . • • . . • . . • • • • • • • • • • •• •$
2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . • • • • • • • •• • • • •
Interest table rate-❑ 3.5% ❑6% ❑ 10% ❑Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
•
NAME OF LIFE ANNUITANT DATE OF BIRTH �EAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
p Life or ❑Term of Years
1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$
2. Check appropriate block below and enter corresponding number . . . . . . . . . . . . . . . . .
Frequency of payout—❑ Weekly(52) ❑ Bi-weekly(26) ❑ Monthly(12)
❑ Quarterly(4) ❑ Semi-annually(2) ❑ Annually(1) ❑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—❑ 3.5% ❑6% ❑ 10% ❑Variable Rate %
6. Adjustment Factor(See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .
7. Value of annuity—If using 3.5, 6, or 10%,or if variable rate and period
payout is at end of period, caiculation is Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . • .$
If using variable rate and period payout is at beginning of period, calculation is
(Line4xLine5xLine6) + Line3 . . . . . . . . . . . . . . . . . . . . . . . . . . • , • • • • • , • • • • • . • • • • • . •$
NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the
tax return.The resultin9 life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return.
If more space is needed, use additional sheets of the same size.
REV-1644 EX+(p1-10)
� pennsylvania lNHERITANCE TAX
� DEPARTMENTOFREVENUE SCHEDULE L
INHERITANCETAXRETURN REMAINDER PREPAYMENT
RESIDENT DECEDENT
OR INVASION OF TRUST CORPUS
I. ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
This schedule is appropriate oniy for estates of decedents dying on or before Dec. 12, 1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal).
II. REMAINDER PREPAYMENT:
A. Election to Prepay Filed with the Register of Wills on
(Date)
B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income
or Annuitant(s) of Election or Annuity is Payable
C. Assets: Complete Schedule L-1
1. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . .$
3. Closely Held Stock/Partnership . . . . . . . . . . . . .$ _
4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . .$ _
5. Cash/Misc. Personal Property . . . . . . . . . . . . . .$ _
6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ ___
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . .$
2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . .$
3. Value of Non Includable Assets . . . . . . . . . . . . .$
4. Totai from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
E. Total Value of Trust Assets (Line C-6 minus Line D-4) . . . . . . . . . . . . . . . . . . . . . . . . . . .$
F. Remainder Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G. Taxable Remainder Value (Multiply Line E by Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
(Also enter on Line 7, Recapitulation)
III. INVASION OF CORPUS:
A. Invasion of Corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income
or Annuitant(s) Corpus or Annuity is Payable
Consumed
C. CorpusConsumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
D. Remainder Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E. Taxable Value of Corpus Consumed (Multiply Line C by Line D) . . . . . . . . . . . . . . . . . . . .$
(Also enter on Line 7, Recapitulation)
REV-1645 EX+(11-09)
� pennsylvania lNHERITANCE TAX
DEPARTMENT OF REVENUE SCH E DU LE L��
INHERITANCETAXRETURN REMAINDER PREPAYMENT ELECTION
RESIDENT DECEDENT -ASS ETS�
I. ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
II. ITEM NO. DESCRIPTION VALUE
A. Real Estate (Please describe.)
Total Value of Real Estate $
(Include on Section II, Line C-1 on Schedule L.)
B. Stocks and Bonds (Please list.)
Total Value of Stocks and Bonds $
(Include on Section II, Line C-2 on Schedule L.)
C. Closely Held Stock/Partnership - Please list. (Attach Schedule C-1 and/or C-2.)
Total Value of Closely Held/Partnership $
(Include on Section II, Line C-3 on Schedule L.)
D. Mortgages and Notes (Please list.)
Total Value of Mortgages and Notes $
(Include on Section II, Line C-4 on Schedule L.)
E. Cash and Miscellaneous Personal Property (Please list.)
Total Value of Cash/Miscelianeous Personal Property $
(Include on Section II, Line C-5 on Schedule L.)
III. TOTAL (Also enter on Section II, Line C-6 on Schedule L.) $
If more space is needed, attach additional sheets of paper of the same size.
REV-1646 EX+(�1-09)
� pennsylvania lNHERITANCE TAX
' DEPAHTMENTOFREVENUE SCHEDULE L��
INHERITANCETAXRETURN REMAINDER PREPAYMENT ELECTION
RESIDENT DECEDENT
-CREDITS-
I. ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
II. ITEM NO. DESCRIPTION AMOUNT
A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets
Reported on Schedule L-1 (please list)
Total Unpaid Liabilities $
(include on Section II, Line D-1 on Schedule L)
B. Unpaid Bequests Payabie from Assets Reported on Schedule L-1 (please list)
Total Unpaid Bequests $
(include on Section II, Line D-2 on Schedule L)
C. Value of Assets Reported on Schedule L-1 (other than unpaid bequests listed
under"B"above) that are Not Included for Tax Purposes or that Do Not Form
a Part of the Trust.
Calculation as follows:
Total Non Includable Assets $
(include on Section II, Line D-3 on Schedule L)
III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $
If more space is needed, attach additional sheets of paper of the same size.
REV-1647 EX+ (02-SO)
� pennsylvania SCHEDULE M
�.'� DEPARTMENT OF REVENUE FUTURE INTEREST COMPROMISE
INHERITANCE TAX RETURN
RESIDENT DECEDENT (Check Box 4a on REV-i5oo)
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
This schedule is appropriate only for estates of decedents who died after Dec. 12, 1982.
This schedule is to be used for all future interests where the rate of tax that will be appiicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument that created the future interest and attach a copy to the tax return.
❑ Will ❑ Trust ❑ Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within
nine months of the decedenYs death, check the appropriate box below and attach a copy of the document in which the surviving �ouse
exercises such withdrawal right.
❑ Unlimited right of withdrawal ❑ Limited right of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amountoffutureinterest . . . . . . . . . . . . . . . . . . • . • . • • • • • • • • • • • • • • • • • • • • • • • • • , • •• • • • • $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(Also include as part of total shown on Line 13 of REV-1500.) . . . . . . . . $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check one. ❑ 6%, ❑ 3%, ❑ 0% . . . . . . . . . . . . . . . . . . . . $
(Also include as part of total shown on Line 15 of REV-1500.)
4. Value of Line 1 taxable at lineal rate
Check one. ❑ 6%, ❑ 4.5% . . . . . . . . . . . . . . . . . . . . . . . . . . $
(Also include as part of total shown on Line 16 of REV-1500,)
5. Value of Line 1 taxable at sibling rate (12%)
(Also include as part of total shown on Line 17 of REV-1500.) . . . . . . . . $
6. Value of Line 1 taxable at collateral rate (15%)
(Also include as part of total shown on Line 18 of REV-1500.) . . . . . . . . $
7. Total value of future interest(sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . $
If more space is needed, use additional sheets of paper of the same size.
REV-1648EX(02-09) SCHEDULE N
� pennsylvania
� DEPARTMENTOFREVENUE SPOUSAL POVERTY CREDIT
Bureau of Individual Taxes
PO Box z8o6oi FOR DATES OF DEATH Ol/01/92 TO 12/31/94
Harrisbur PA i7i28
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
• • ' •
i . Taxable assets total from Line 8(cover sheet) . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . .. . .. . . . 1 .
2. Insurance proceeds on life of decedent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . 2.
3. Retirementbenefits . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 3.
4. Joint assets with spouse . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . 4.
5. PA Lottery winnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
. . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . .
6a. Other nontaxable assets: List and attach schedule if necessary . . 6a.
6b.
6c.
6d.
6. SUBTOTAL(Lines 6a, b,c,d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 6.
7. Totalgrossassets(AddLineslthru6) . . . . . . . . . . . . . . . . . • . • • • • • • • • • • • • • • • •. • • , • • • •• • • . • • • • 7•
8. Total actual liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 8,
9. Net value of estate(Subtract Line 8 from Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 9.
If Line 9 is greater than$200,000-STOP. The estate is not eligible to claim the credit If not, continue to Part II.
� • � � • . � - � - � • �
� � - - � - � � •
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse . . . . . . . . . . .. Sa. 2a. 3a.
b. Decedent . ... .. . . . . ib. 2b. 3b.
c. Joint . .. . .. . .. . . . . . lc. 2c. 3ci
d. Tax-exempt income . .. . ld. 2d. 3d.
e Other income not
listed above .. ... . . . . ie. 2e. 3e.
f. Total lf. 2f. 3f.
4. Average joint exemption income calculation
4a. Add joint exemption income from above:
(lf) + (2f) + (3f) _
(-3)
4b. Averagejointexemptionincome . . . . . . . . .. . . . . . . .. . . . . . . . . . . .. . . . ..• • • •• • • • • • •• • • • • • • • • • _
If line 4(b)is greater than$40,000-STOP. The estate is not eligible to claim the credit If not,continue to Part III.
� � • • ' • � • ' � � • I
1. Insert amount of taxable transfers to spouse or$100,000,whichever is less . . .. . . . . . . . . . . . . . . . . . . . . 1,
2. Multiply by credit percentage(see instructions) . . . .. . . . . . . . . .. . . . . . . . . . . .. . . . . . . .. . . .. . . . . . Z,
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on Line 18 of the cover sheet. . . . . . . . . . .. . . . . . . .• • • • • • • • • • •• • • • 3•
4. For nonresidents,enter the ratio of the decedenYs gross estate in PA to the value of the
decedent's gross estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Multiply Line 3 by Line 4 and enter the total here.This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . . . . . . . . . 5•
REV-1649 EX+ (O1-14)
�pennsylvania SCHEDULE O
DEPARTMENTOFREVENUE DEFERRAL/ELECTION OF
INHERITANCE TAX RETURN SPOUSAL TRUSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
❑ PART A - DEFERRING STATEMENT
For all trust assets reportable for Pennsylvania inheritance tax purposes for which a deferral of tax is chosen, the personal
representative responsible for filing the return and the trustee(s) of the trust in question hereby acknowledge the department's
Statement of Policy set forth at 61 Pa. Code § 94.3 concerning any potential termination of the trust under 20 Pa.C.S. § 7710.1
that occurs after the return was filed.
❑ PART B — ELECTION TO TAX AMOUNTS
Complete this seciton only if making the election to tax the sole use trust.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election
applies to the Trust (marital, residual A, B, bypass, unified credit, etc.).
Enter the description and value of all interests for which the election is made.
DESCRIPTION VALUE
Total
If more space is needed, insert additional sheets of the same size.
REV-1503 EX+(8-12)
� pennsylvania SCHEDULE B
;� DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARTHA M GATES 21-13-0601
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
41. UNITED STATES SAVINGS BOND - SERIES EE - M17855309EE 1, 968.40
42. UNITED STATES SAVINGS BOND - SERIES EE - M17855310EE 1, 968.40
43. UNITED STATES SAVINGS BOND - SERIES EE - M17855311EE 1, 968.40
44. LTNITED STATES SAVINGS BOND - SERIES EE - M17855280EE 1, 968.40
45. UNITED STATES SAVINGS BOND - SERIES EE - M17855281EE 1, 968.40
46. LTNITED STATES SAVINGS BOND - SERIES EE - M17855282EE 1, 968.40
47. UNITED STATES SAVINGS BOND - SERIES EE - M17855283EE 1, 968.40
48. UNITED STATES SAVINGS BOND - SERIES EE - M17855284EE 1, 968.40
49. UNITED STATES SAVINGS BOND - SERIES EE - M17855285EE 1, 968.40
50. UNITED STATES SAVINGS BOND - SERIES EE - M17855286EE 1, 968.40
51. LTNITED STATES SAVINGS BOND - SERIES EE - M17855287EE 1, 968.40
52. UNITED STATES SAVINGS BOND - SERIES EE - M17855288EE 1, 968.40
53. UNITED STATES SAVINGS BOND - SERIES EE - M17855289EE 1, 968.40
54. UNITED STATES SAVINGS BOND - SERIES EE - M17855290EE 1, 968.40
55. UNITED STATES SAVINGS BOND - SERIES EE - M17855291EE 1, 968.40
56. L7NITED STATES SAVINGS BOND - SERIES EE - M17855292EE 1, 968.40
57. UNITED STATES SAVINGS BOND - SERIES EE - M17855293EE 1, 968.40
58. LTNITED STATES SAVINGS BOND - SERIES EE - M17855294EE 1, 968.40
TOTAL(Also enter on line 2,Recapitulation) $ 3 5,4 31.2 0
If more space is needed,insert additional sheets of the same size
• ' �,.._�.�.
-���
__._._ ------ - _ ______. -----___ �_.
�-..:: -_.-�'ti=�',s CL�
�AST W�LlL AND TESTAMENT
OF
MA►.R�'HA M. GATES -�
I, I��RTHA M. G:�TES. ei =?� «���le�- Dri��. a�a�r�ert �10=�, Mechanicsburg,
Cun3berland Cot�nt• . �Li�.ns��l�ania LZZLIGl� �hi= to ^� in�� Last «'ill and re�oke any V�'ill or
Codicil pre��ousi� n�ade b� me
;
I'T�M[ I: I d'uect that all expenses of my last illness and fui�.eral including my
grave�narker and perpetual care shall be paid from my residuary estate as soon as practicable
after my decease as a part of the expense of the administration of my estat�,
IT�M II: I devise and bequeath all of my estate of every nafure and wherever situate
in equal shares, share a�id share alike, to each of my five (5) children, itUBERT S. GATES,
now of Mechanic�burg, Pennsylvania; MARJORIE BOWERS, now of Harrisburg,
Pennsylvania; JaHN P. GATES, now af Safety Harbaur, Florida; NANCY J. B�NSQloF, now
oi Schenectady, New York; and DENjS E. GA'I"ES, now of East Hempstead, New York,
providmg that each sha13 survive me. In the even# that any of my children fa,il to survive me,
their share lapse and r.ny Estate shall be divided equally between �ny �-einaining, surviving
children.
ITE1'� I�I: i direct that all tales that ma�� be asszsszd :n consequence of m�- death of
•.-yliate���r nature and by ���hatet er auri�diction i����c��z� �hail �e paid from my residuary estate as a
part of the expense of the acilxz�i�istrat2o2i of my�estate and �c�thout apportionment.
�
�
�TE1VI IV: I appoint my son, R�SERT �. GATES, Executor of this, my Last Wil1, �
,
Should my son, R�BERT B. GATES, fail to qualify or cease ta act as Executor, I appoint my
daughter, Nd1�RJOR�E BUWERS,Executrix of this,my Last Will.
I
;
IN WITNESS WHEREUF, I have hereunto set my hand this 2nd day of February, �
c
1998. ,
�-' /,�r ._�;�. (: .�_-
s��:`
MARTI�A M. �ATES
;
__� --__".� __ =�:��run_:nt. caizsisting af this and one (lj other Typev�7itten pa�e=.
ident:i:;:a ��- .�� �;�narurz o'r the Testatnx MART�iA 1VI. GATES, was o� the dar• and dai�
tl�zrzof si�r�eu. pubiished and declared by MAR7CHA M. GATES, the Tes�atrix herein nam�d.
as az�d tor her Last Will, in the presence of us, who_ at her request and in her presence an� in tl��
presEnce of eacli other, llave s«bscri�eu our i�a�7��� a� �cirn��s.� ?�zrzio
� r., �� i - � ._
� ,•:.;ti�,,, � . , . J.. ; L _ ...�`-� of ! ,�' �.� �.'.�;`�_�' � ��;f-
_ �
� �• �Y _ af ,f , - �;
,
,
�
�.���o���LEn�����T
CQ'����p���-E.�LTI-� OF PE\\SI�I.���`IA .
, SS.
CQL�T�'C)F D�LTPH�ti •
I; �I:�R`I'�-L� 11. G:�TES. the TestaFriY �����a�� nam� i� signed to thz attached �r
foreboing instrument, having been du1�- q_ualified aecord'zng to law, do hereby ackna�i�led�� that I
sigi�ed and executed the instrument as my Last Wili; and that I signed it wiilingly and as my freE
and valuntary act ior the purposes tl�erein expressed.
Swoxn to or affirmed and aclulowledged before me by MARTHA M. GATES, Testatrix
this 2�id day of February, 1998.
� y .l
/ . f<l 'r)..� �
MARTHA li�t. GA�'ES �,,..,`
.-,�
i� �l
T t !
1 � �
1' . � ;,i/ d � ��
! ... _' .
� . 'r _. '�.
� Notary Public
N07Ar;lAL SEp,�
� BRUGE D FOAEMAA �'orary Publ�c
r
City oi harrsburgh,Dauphin CoUn�y
h� Commiss�on Ex rres Sept.25, 19gg
�
fv�)+.�i';i—�� ;=��.— ! � �J� ipL��ti7 �.`._-�._�i.� .
: SS.
CO���T�. C�� D�.[�PH�\ .
�',�. Ti1e u�dzrs��?:e� -_--=-___ :�;_ --_'___ �. - _-'e:i to ihe attach�� or iore�oin�
;�.., ,�... ,, - -- - -- ------ - -- -- - - --- - - - - - - --- - _ -
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���v- t3�=- ;._.�.:_�� _ - �::: :����== =--� �_�__��?�--= •__ -=�- __�� �__� .__-.a:�- act ior tli� purpesz�
chzrein e4przs�e�: �hat 2ach subsc.ribing E�rtness ir the hearu7� and sight of the Testatri� sianed
the �'ill as a v���tness; and that ta the best of our knowledge, the Testatrix was at thai time 1$ or
mare years of age, of sound rnind and under no cons#rain# or undue infiuence.
Sworn to or affirmed and subscribed before me by the undersigned w�itnesses, this 2nd
day of February, 1998.
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hIOTARlAL �cAL
$RUCE D FOREMAN Netary public
City of Harrisbur��, pa��p���rounty
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