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Home My WebLink About03-24-15 (2) J *`, pennsylvania 15 U 5 618 4 0 3 � DEPARTMENTOFREVENI{EX�0.3-�4� t OFFICIAL USE ONLY REV-1500 Bureau of Individual Taxes county Code Year File Number PO Box zsoso� INHERITANCE TAX RETURN Harrisbur4 PA 17128-0601 RESIDENT DECEDENT 21 14 7 5 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 06 27 2014 09 17 1909 DecedenYs Last Name Suffix DecedenYs First Name MI GATES EMMA R (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x 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 � 2. Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � q. Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate � 8. Decede�t Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) � 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets � 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ROBERT C SAIDIS ( 717 ) 243 6222 First Line of Address 26 W HIGH STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17❑13 Correspondent's email address: �aidis anssr-attorneys com REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONIY �' ^� . _ ,:.7 DATE FILED MMDDYYYY {'� ''� 1, `�3 r 'u.) �.7 .�.�,. _.:.„ � -'� ��;.� .. .,_, ....._ ....... .._. _.::� -._,� �.27 . ..�� . . .... �' ,. , .,. _f:� DATE FILED STAMP _„�,� . � : � �w� _� �."1 , r_. Side 1 �� .. _,� I I�IIII III�I�IIII III�I�IIII�IIII II��I I�III�IIII�II�I IIII I��I � 1505618403 1505618403 � � � 1505618411 REV-1500 EX Decedent's Social Security Number �ecedent's Name: GateS, Emma R. RECAPITULATION 1. Reai 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. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 2 8 8,418 • 21 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 4 9,2 9 2- 7 5 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 3 3 7,710 • 9 6 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 3,2 5 0 • 0 0 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 1,7 31 - 19 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 4 ,9 81 - 19 12. Net Value of Estate(Line S minus Line 11).......................................................... 12. 3 3 2,7 2 9 • 7 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 1,0❑� • 0❑ 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 3 31,7 2 9 • 7 7 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.00 15. 0 • 0 0 16. Amount of Line 14 taxable at lineal rate X .045 3 31 ,7 2 9 • 7 7 16. 14 ,9 2 7 • 8 4 17. Amount of Line 14 taxable at sibling rate X.12 ❑ - D 0 17. 0 - 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 • 0 0 18. 0 • 0 0 19. TAXDUE................................................................................................................ 19. 14 ,927 • 84 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNA E ERSON.& N I O ING RETURN �effrey L. Gates DATE/ - � '� / ADD S 2395 L, ch ri echanicsburg, PA 17055 SIGNA• RE OF P THAN REPRESENTATIVE Robert C. S8ICIIS DAT � � �3 �� DDRESS 26 W. High Street, Carlisle, PA � I IIIIII II�) �IIII I�I�I'llll III'I IIIII IIIII III'I III�I III)II') Side 2 1505618411 1505618411 J REV-1500 EX Page 3 File Number 21-14-754 Decedent's Complete Address: DECEDENT'S NAME Gates, Emma R. STREET ADDRESS 2395 Lobach Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 14,927.84 2. Credits/Payments A. Prior Payments 12,000.00 B. Discount 631.58 Total Credits(A +B) (2) 12,631.58 3. Interest �3� ----- 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box 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) 2,296.26 Make Check Payable to: REGISTER OF WILLS, AGENT �k .:,-� n.�.`.... a �":.o'�v- r�.": '�, a�' �wg ��a� �^��: ��S� �ry �.T�•._ �E��:�& �-�+�.:-.��. .,��4 t'��h` .��r- .�� .°�..�G , .. x; Nr _• i'� .S�k„ :�p� ..ft a*lii� '��`�� xisw�.'-�a�.�«'s-,: :�,�'�-' 3R��'_'�"�a�'�� -. ..r.;,�i _ r�... . �'U': ..... w�� .` ,� ��, , .. ..�i ... .. . 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:............................................................................... � � b. retain the right to designate who shall use the property transferred or its income:.................................. � � c. retain a reversionary interest;or............................................................................................................... d. receive the promise for life of either payments,benefits or care?............................................................ � � 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?....... I�1 �I 4. Did decedent own an individual retirement account,annuity,or other non-probate property which r� � contains a beneficiary designation?................ ................................................................................................. I 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. � � a�i� ; �'' �w G� ,„ , h�4' c � „ ��"i_��..��i�+�?�� .�dt-"s ,�w,M. ��ft� �Fs�°'.�ilr�...��. .: . -� . I�F� �. �. m. «.. < .�9 ,�. R�> .�re..� . .afi��rs,tli ��i"a .�. �d �t� �°�� .,a �; ,h. �: 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 January 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 step-parent 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 beneficiaries is 4.5 percent,except 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 decedent,whether by blood or adoption. Rev-1508 EX+�OS-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFREVENUE P E RSO NAL P ROP E RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gates, Emma R. 21-14-754 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Ameriprise Financial Mutual Fund Account No.01254050734 002-transfer on death to 22,696.09 Jeffrey L.Gates-See attached letter from Benkovich&Associates dated July 29, 2014 2 Ameriprise Financial Mutual Fund Account No.01434050734 002-transfer on death to Jeffrey 81,695.85 L. Gates-See attached letter from Benkovich 8�Associates dated July 29, 2014 3 Highmark-Refund from health insurance 746.02 4 Wells Fargo Account No.3614-1509-transfer on death to Jeffrey L.Gates,Julie A. Fake, 183,280.25 Michael L. Gates and Diane E.Gates -See attached letter from Wells Fargo dated July 14, 2014 TOTAL(Also enter on Line 5, Recapitulation) 288,418.21 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) JUL 3 0 2�kovich&Associates � ivate wealth advisory practice ofAmeriprise Financial Services,Inc. ° Suite 300 4661 Trindle Road Benkovich & Associates Camp Hill,PA 170115603 Tel:717.761.4208 July 29, 2014 Fax:717.761.6282 Toll Free:800.962.8694 Thomas F.Benkovich CFP�,ChFC� Private Wealth Advisor $81d15, Sullivan & Rogers CERTiFieo FiNnrvaa�P�nNrveR�"^praetitioner 26 West High Street thomas.f.benkovich@ampf.com Carlisle, PA 17013 William K.Pressmann ChFC� Associate Financial Advisor Attn: Robert C. Saidis Chartered Financial Consultant�°' william.k.pressmann@ampf.com Re: Estate of Emma R. Gates Julia A.Stuart Paraplanner julie.a.stuart@ampf.com We have received your letter informing us you represent the estate of Laure E.Kane EI71fT18 R.Gdt25. Office Manager laure.e.kane@ampf.com Account Summary 1)Type of investment: Mutual Fund Product Name: Mutual Fund Total Account Value(as of Date of Death): $22,696.09 Account Number:01254050734 002 10/08/1996 Account Registration: Emma R Gates TOD(non-qualified) Beneficiary Designation: PRIMARY BENEFICIARY: JEFFREY L GATES SON 100.00% 2)Type of investment: Mutual Fund Product Name: Mutual Fund Total Account Value(as of Date of Death): $81,695.85 Account Number: 01434050734 002 04/11/1997 Account Registration: Emma R Gates TOD(non-qualified) Beneficiary Designation: PRIMARY BENEFICIARY: JEFFREY L GATES SON 100.00% I am enclosing the Certified Death Certificate you enclosed with your letter. Mr. Gates provided us with a Certified Death Certificate with the required Estate Settlement Claim form. The accounts have been re-titled to his ownership. If you have any questions, please do not hesitate to contact me. Sincerely, � Laure E. Kane Enclosure: Certified Death Certificate Cc: Jeffrey L. Gates An Ameriprise Financial franchlse.Ameriprise Financial Services.Inc.offers financial advisory services,Investments,insurance and Ameriprise � annuity products.RiverSource�and Columbia Management products are offered by affiliates of Ameriprise Financial Services,Inc., FIi7AY1C1A� Member FINRA and SIPC. �• , - Wells Fargo Advisors,LLC Three Lemoyne Drive � Lemoyne,PA 17043 � € '� �� - Te1:717-761-7344 � ; Fas:717-975-8426 July 14, 2014 Jeffrey L. Gates, Executor The Estate of Emma R. Gates 2395 Lobach Drive Mechanicsburg, PA 17055-5375 RE: Emma R. Gates "Transfer-on-Death" Account No. 3614-1509—Established 02/12/1937 Date of Death:June 27, 2014 Social Security No. 194-28-8526 Emma R. Gates &Jeffrey L. Gates Account No. 2138-9788—Established 08/30/2010 Date of Death:June 27, 2014 Social Security No. 194-28-�525 Dear Mr. Gates: �, I would like to extend my deepest sympathies for your recent loss. Enclosed please find the recent date of death values for the above accounts here at Wells Fargo Advisors. The values were a result of taking the high and low prices of the day and taking the average. If you have any questions regarding the enclosed information, please do not hesitate to contact me at (717) 761-7344. Sincerely, eQ,, � . Bruce D. Mulvey Associate Vice President—Investments BDM: le Enclosure � �� - - ; �� - .,` , < ,: , Member FINRA/SIPC � ` ` , ACCOUNT INFORMATION REPORT _ Prepared for: The Estate of Emma R. Gates Jeffrey L. Gates, Executor and the Law Offices of Saidis, Sullivan and Rogers 26 West High Street — Carlisle PA 17013 ACCOUNT NUMBER AND REGISTRATION `�'ells Fargo Advisors,LLC Account number: 3614-1509 Registration Emma R. Gates TOD Registration Account Opening Date February 12, 1997 �ccount Type Retail Brokerage with TOD (Transfer on Death dated 10/02/2003) Beneficiary Information Named Bene£ciary Relarionship Percent of Account Jeffxey L. Gates Son 94% Julie.�.Fake Granddaughter 2% llichael L. Gates Grandson 2�0 Diane E. Gates Granddaughter 2% �sset Listing as of June 27,2014 See Tab I Enclosed Statement ending June 30, 2014 See Tab II Statement ending July 31, 2014 i ! j: � � t Page 2 Estate of Emma R. Gates Account No. 3614-1509 WY38- Emma R. Gates- Established 02/12/1997 Date of Death:June 27, 2014 SS# 194-28-8526 ' Amount Security Price Value Common Stocks 200 Altria Group, Inc 41.86/41.13 41.495 8,299.00 300 Enterprise Products Prtnr 78.16/77.27 77.715 23,314.50 200 General Electric Company 26.43/26.23 26.330 5,266.00 � 200 The Nershey Company 97.12 /95.97 g6.545 19,309.00 200 Philip Morris International �6.17/84.05 85.110 17,022.00 100 Scana Corp (New) 53.50/ 52.95 53.225 5,322.50 Mutual Funds-Closed End = 300 Delaware Div& Income Fd 10.71 / 10.57 10.640 3,192.00 Mutual Funds-Open End 5961.151 Delaware High Yield Opport 4.46 / 4.46 4.46 26,586.73 1429.310 Franklin PA Tax Exmpt Fd 10.32 / 1�.32 10.32 14,750.48 1011.733 Income Fund of America 21.74/ 21.74 21.74 21,995.08 2204.191 Lord Abbett Bond Deb 8.39 / 8.39 8.39 18,493.16 226.555 Washington Mut Invs 41.69 /41.69 4�1.69 9,861.98 Cash- Money Market Fund 9867.82 Bank Deposit Sweep 1.00 / 1.00 1.00 9,867.82 TOTAL: $183,280.25 "This has been prepared solely for information purposes, and does not supersede the proper use of your Wells Fargo Advisors client statement,which is considered the only official and accurate record of your account. If there are any discrepancies between this and your client statement, please call your local branch manager." Rev-1509 EX+(01-70) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gates, Emma R. 21 If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jeffrey L. Gates 2395 Lobach Drive Son Mechanicsburg, PA 17055 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S VALUE OF ITEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE DECEDENT'S INTEREST NUMBER INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 12/05/1991 PNC Bank Account 5140377152 -See 43,066.05 50.000% 21,533.03 attached letter dated February 25,2015 from PNC 2 A 08/30/2010 Wells Fargo Account No. 2138-9788-See 55,519.43 50.000% 27,759.72 attached letter from Wells Fargo dated July 14,2014 TOTAL(Also enter on Line 6, Recapitulation) 49,292.75 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10) ACCOUNT INFORMATION REPORT Prepared for: The Estate of Emma R. Gates Jeffrey L. Gates, Executor and the Law Offices of Saidis, Sullivan and Rogers 26 West High Street Carlisle PA 17013 ACCOUNT NUMBER AND REGISTRATION Wells Faxgo Advisors,LLC Account number: 2138-9788 Registration Emma R Gates and Jeffrey L. Gates J'I'��ROS Account Opening Date August 30,2010 Account Type Retail Brokerage Asset Listing as of June 27,2014 See Tab I Enclosed Statement ending June 30,2014 See Tab III Statement ending July 31,2014 Page 3 The Estate of Emma R. Gates Account 2138-9788– Emma R. Gates &Jeffrey L. Gates– Established 08/30/2010 Date of Death: June 27, 2014 — SS# 194-28-8526 Amount Security Price Value � Municipal Bonds 25000 Cecil Twp PA Mun Auth Sewer Rev Gtd AGM Insd 97.409 24,352.25 3.80% due 02/01/2038 Call 08/01/2017 @ 100.000 386.94 Accrued Interest: 30000 Wayne County PA General Obligation AGM Insd 101.718 30,515.40 3.80% due 11/15/2026 Call 11/15/2015 @ 100.000 135.00 Accrued Interest: Cash–M�ney M�rket Fund 1,00/ 1.00 129.84 129.84 Bank Deposit Sweep ___________ TOTAL: $55,519.43 "This has been prepared solely for information purposes, and does not supersede the proper use af your Wells Fargo Advisors client statement,which is considered the only official and accurate record of your account. If there are any discre�ancies between this and your client statement, please call your local branch manager." 02-25-15;03: 28PM;PNC MECHANICSBURG BRANCH ; i�7-6°1-4076 # 2� � ��,��• • . A , � • Febzue�y 25,2015 . 'VVanda Wert ��TC Bank - . Mechanicsbnr�Branch � � g�: E�ma R.Crates . SSN; 194-28�8526 . DOD: 06-27-2014 ' Dear Ms Wert: � . Tn respoz�sc to your request for 17ate of T3cath{DOr)}balances for thc custoz��cz noted above, our records show the following; Checkin�Accout�t . rstablishcd: X2��5-]991 A,ccoun.t##5140377152 , E�A�,�}ATES �EF�RE f�GAT�S DOD balance: $43,465.93 +0.J.2 acczved iz�terest � . Interest paid 01-4�-2014 thru Ob-27-2014 �2.00 Y'TD Please note t�at this of.�xoo providcs datc o�dcath balanccs for d�posit accoun,ts{T.�2As, CA,,,�s ,Chcoking�d � . Satiings). 'Wc�o not proctss any 5nancial transnctions or providc statcments_ If you�eed assistnnc�•with� �, • a,n�of these itcros,plcasc call 1-888-PNC-BAI`��(1-888'76z-Zz6S)ox stop by�our loCa.!�NC�s�nnk brttnch � office. ' Sincctcly, Nat�ozl.al F'i�ancisl Services Center PNC Bank,N.A. � � , Memb�r FDIC This mess�ge �s intended for the use of the indfvid'udI or e�ttity to which it is uc�'dressed ar,d may , COni�in �lzformatron that is privilegecl, eonftdent�al�nd exempt from dtsclosure under ppplicable law. If ihe reader of rhis message Ys not ihe i�tended recipie�r or rhe employee or pgertc responsible for detivering this message to the intended recipient, _� are hereby noti�ed that a�ty dissemination, distribu�ion or copying of this cornmunicatiores is sti'ictly prohibited. I�you have received this communication in error,please notify me immedicrtely by reply or by telephone at 80Q--762�1775 and immedrately desrroy rizrs fa,red documenl. ' � , � � � Page 1 of 1 REV-1511 EX+�08-73) gC H E D U LE H pennsylvania DEPARTMENT OFREVENUE F U N E RAL EXP E N S ES AN D INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gates, Emma R. 21-14-754 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MBER q, FUNERAL EXPENSES: Brachendorf Memorials 220.00 g. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid z. Attorney's Fees Saidis, Sullivan 8� Rogers 3,000.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zio Relationshia of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 30.00 7. Other Administrative Costs See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 3,250.00 Copy g ( ) Form PA-1500 Schedule H(Rev.08-13) ri ht c 2013 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Gates, Emma R. 21-14-754 ITEM DESCRIPTION AMOUNT NUMBER Other Administrative Co� 1 Register of Wills-Filing fee for Inheritance Tax Return and Inventory 30.00 H_B7 30.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+�12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gates, Emma R. 21-14-754 RepoR debts i�curred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 Country Meadows Home 88.00 2 Country Meadows-West Shore 797.05 3 Diamond Pharmacy 101.93 4 In Your Home Cares 385.00 210.00 5 In Your Home Cares 149.21 6 West Shore EMS TOTAL(Also enter on Line 10,Recapitulation) 1,731.19 (If more space is needed,additional pages of the same size) Form PA-1500 Schedule I(Rev. 12-12) Copyright(c)2012 form software only The Lackner Group, Inc. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-14-754 Gates, Emma R. RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NAME AND ADDRESS OF DECEDENT (N►ords) �$$$) NUMBER PERSON(Sl RECEIVING PROPERTY Do N t Li t T u tee s TAXABLE DISTRIBUTIONS [include outright spousal I, distributions,and transfers under Sec.9116 a 1.2 Julie A. Fake Granddaughter $10,000 and 2% 5075 Pajabon Drive of Wells Fargo Account3614 Apt.701 -1509 Harrisburg, PA 17111 Diane E.Gates Granddaughter $10,000 and 2% 4212 Bibleway Ct. of Wells Fargo Holly Springs, NC 27540 Account 3614 -1509 Jeffrey L. Gates Son $10,000,94%of 2395 Lobach Drive Wells Fargo Acct 3614-1509, 100°/a Mechanicsburg, PA 17055 residue Michael L.Gates Grandson 2%of Wells Fargo Account 37 E. Brookfield Drive 3614-1509 Lebanon, PA 17046 Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1,000.00 1 Alzheimer's Association 1,000.00 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 Form PA 1500 Schedule J(Rev.01-10) Copyright(c)2010 form software only The Lackner Group, Inc. i , ,t 1. � j,_, t---�% . I , � , I �� r,x�sx wz�L �n �sx�r'r'r . ,I . __ __ _ __ _ _ _ : . __ _ ___ _ _ _._.. _ __ . _ o�, � � � � � - � �2,. GA'I`�s . ', ; � � Dau hin County, � �� R. �a��, of Harri�burg, P bea.n.g of �ound an.d di�posing ma.rxd, memory and , Pennsy'7.�rania, -- • . . y . - unde�'standing, da hax'eby make, publ.a.sh an.d declare �his a� and I far m Last Wi11 and '�e��ament, hereby re-voki.ng a].]. other WiJ:l� il Y � and Codici�.s heretofore made by me. , , �zRs� ' � � � last � ust debts and expen.�es a� my j • • I direct �he paYment of mY J. . I e�ta�a ae soon a�ter my death ag � , , � illness an.d funeraX from mY' '� �.,� � . bod be interxed in the � � coza.veniently may b� done. ' Y dj.rect ?nY' Y , � T�� Yark County, Penns�l�ran�.a. ` \�,� Di11�bu.rg Cemetery, Da.11abuxg, . I �"� Further, I authorize my P ersonal.• repx'esentative ta e�en ! y • e�sona]. xep�resentaCa.v ' � funds fxom my estate, in suah amcsunt as mY � � erectib ; •sha11 �oneider ziecessaxy and desirab�.e fox' �he purcha�e, . i and �.nscription. o� a suitable marker for mY 9xave. � � . � � �EGOND . , , '� . � � :t maJce the �ol�owing speci�xc bequest: I ' � , , A.. , The 5um b� one thau�and ($�., 000 .00) dollars to the Natio�.a]. SAIDIS .. SHUFF,F�.OWE�t � Said bequeat �o be. apecifical:ly Li�I.INT�SA'X - A1xhe�.ma� As�oc�.a�iox�. ' � ATTORNB� � � ' • z�w.x�g�,acr�t de��gnated �or re�earch. � Carlisle,PA . ' , � ' , 'I'he. �um of ten thousand ($�� ODO.00) da7.lars �o mY -. . B ' Michae]. Z. da�e�, if liv'�.ng. � ; grandson, . ; , . i I � � � � . __.___.�_--_�__.___- ; + ....----� ', � ..._ ---�--- -. --�---__._ _ .. ... _... .., . ___ ._._..... � � � „ • � � �� I , �4 , � � � c. The sum 4� ten tr�oueana ($1�, oao . aa) dollars to my � _. _ . . . .._ i __.. _ . . �f....��ving, . .. . _.__. � _ ..--.... --- _.. Dia�e E_.....aatias, gxa�.ddaughter, ; � ' D. The sum o� ten �houear�d ($10�000 .00) do�lare to mY I � nddau hter, Ju�.ie A. Fake, i� liv'ing. � , gra 5 'I � �xxz� _ _ 1 - .�.�- , _._..__ _ ... T �ive, devise and bequeath all the rest, residue and , remaiz�de�' of mY es�ate to my son, J'e��reY L• ��ea. �n the . event my son, �'ef�rey' L. c�ate�, fail� to survive me by thirty da e, 'then x giVe, devise and bequeath a11 the rest, .xeaidue and I Y q daughter--a.n-law, Ruth V. Ga�ee. 7n � �}`�, remai.nder af my eetate �o my � !/ fai1� to surv�.ve me � `' � the even.� my daughter-in-law, Ruth V. Gates, � "~--' i�ve deviae and bequeath a1l th� x�� ' by thixty days, then z g , l �, o� m estate to �he issue o� my aon, 4 r��idue anc� remaindex Y ' �a�es, Pex' �tir�es. ', ,7e�frey �+, . . . � I FAURTH ' � � . • , � direct that any and a1X inheri.tanoe, estate, and transfer i . � tax.e's im�osed upon my esta�e pa�sing under tha.s W�.1� ar I otherwise shall be paid out a� the pra.nCipa]. of .m�' r�s�-duaxy , I ' � esta�e. . . FIFTkI SAIDIS . � _ . . . . _ .: � .. .'. ST�UFF,�'�QWEIt � • owe:r� conferred by law, I authorize an,y � &I.T N DSAY In addition to the p . ^'r''°�r`'rw ' undex thi� instxument, in t heix' zG w,x;gu stt�t . e x�o nal repxesen�ative actzn.g , Carlisle,FA � • ' � absol.ute discret�-on: ' � � A. To retain �.n, the form receiv'sd, or ta sell either at , xivate .sale an zeal �or per�or�a1 pxaperty; 1. ` �ublic or p � � 2 . . . _____..._._...___-------------------�----- . � � �� ! i � 1 � , B. To exeraise any opta.ans to subscrxbe �or stocks, --------.. __ _ _. ..___.. _.____.. :........ ....- _ __.____ __ _ ._ _-_-. --bonds, ar other �.nvestmen s; � , C. �o join �.n an.y �1an ,o� lease, mortgage, I i ' consolidation, exchange, r�organization ox fore�losure of '. _ _ any cox-pn�a�ivn_ in which my e�tai:e or any trust may lnold_ ataake, bonds ar ather SeGllx'�.t�e�i ' D To se11, tran.sfex, Gonvey, martgage, pledge, leaae . or exchange any px'opexty� real or pexeonal, which at any � f axt ot my estate, for �he payment of debts � , time may �orm p . ' � o� �a�e�, or far an.y� puxpose o� adminis�.rata�on or �'`J ' d3st�ibution, �or �uch priCes and upon .euch terms as my r reeentative, in their �a1e diaCretion, may d e e m � p�rsonal rep �saa.ae, and .to execute and deliver deede of conveyanae ox' txan�fer thereo£; I i E. To make settl.ement� ar�d compromiae� °� �u�� E�� aa i ' : �, personal represe�tatiYe in thaa-r sol.e discretion may , � • ax�,y court : i deem wise wa.�hout the necasaity o� obta�:nix�g � . . � . 4 . . . . . . . ` ; appx�aval thereo�; � � • F. Ta make distributiori hex'eura.der, either in cash or ' i � � D�5 ' kind, as mY P��'�onal representative ir�. their discretion maY ; SAI _ _ .... . ._ � . gr�,FLOWER ' . .. . .. - . ' & J.INDSA'Y � deem w�se. • � � ATfORNE� , • � ; z6 W.�h Sh�eet• �IX��I. - Carlisle,PA I da h.ereby nominat�, �co��atu�e and appoix�.� my son, . '�� to act as Executnr o� thi� my Last Will and I Jef��'ey I.�. C3a�e�, ! 'I • � � howev'ex, tha�. if Je�f�:ey L. Gates i� � � . Teatament. Pxov�.ded, i 3 �i ; • � . . , , �� i • ; __.__._ ..__.__._.._...._._..___—� , _...._..._ --•- I -.... .,._.._._�_..�_-----•.__._ ; ..._ ...... __._... i ° ' � �1 � � 'r,' unwil�ing or unable �o act as Executor, I dixec� the duti.es of i ' _....._ _...._.. - . _._ _.__ .__.. .-- ---.... _ _. .._.__ ..__..._ _._ _._ ._._. --- - _.._ -- � - . -- --._ _ F�xeCutx'ix to be performed by Ruth V. aa�es. In tlie_even __. ' I V. �at�,� i� Gtr�wilJ.ing or u�able to aCt as Executri�., I d�.rect ' i the duties of Executrix to be pexformed by ��axie E. Gates. ; . • ..._ ..., .._..._. . _ 3EVFN'�'H __... . ..... .. ._ .._.. ...._ _ ......_. I direct that no p��'sonal re.pxesen�ati�re, guardian, truatee or qther �iduciary appo��d una�:x Chis instrument ehal�. be �' required �o give bond for the faithf�ul Performance o� thea.r � duties in anY juxi.�diotion. ; IN WITN�Ss WH�REOF, Z, Emma R. �a�es, hav� hexeunta �e� my � hand and aeal to thi� my La�t Wi11 and Testament, con.aisting o� �our typew�i.tten pagea, the fir�t thz'ee ,af which bEa�' m�' . ' thi.e ��c�.ay of . in.i��.a1s ir� the margin for identification, __�� , 2 0 0 3 . . ,..� `�j _• . �,,ly � � � / `��'J Emma R. C3a es . ' ' � ublished axad �declared by the above�named I Signed, seaJ.Ed, p . '' F�nz►a R. Gatee, Testatxix, as and for har Las� Wi].7. and Testament I� ' in the pzesen.ce of us, who have hexeun�to �ubecxa.bscl oux n.ames at ' . her�xequest as witrie��es there�o, in the pxe�enae of said � SAIDIS ' . _. �� SHUFF,FLO'4UER Testatrix and o� each o�her. . ..... ...._. . :-- �- . '• ' &T.�INDSAY A17D�2.�5 S �.�r Lt.�c.-�' ,Sh-r<�,�" inrron,.,_„ �5�, �n_T'[rFw '�r,,rn/\ ��.r.--�--- • . ' � 2G W.Nigh Street • ' ��, ' ' Corliele,PA �,G�,,. �- c t I // . ' ' -/' c��C�� /��'?�-e"�-�"��_.__��.---- , � . ADDRESS I i . . 1 i ' � 4 . i • . . i . . � . . . ...._. :_...___..__.._._—._._�^-_______.._...___.....__�._._�,...._------- � ----- -----.._ . -- • - I o ' � r�l �1 . � ' � .' ; t, � i COMMQYd4J'EATaxTi OF k�ENNSYL'V'ANIA • ' _.._ � —..------------ -------------...--__ __.__. _ _. _ �------ - ----- .._.._ _ �. _ CO'UN�Y 0�-__._..__ __-CUMB'�ERT��12�D--s ----- �...ae r,n l,c-��-. and ` We, Emma R. G��e�, � �,Cw______r��__a! 0�.1_____, �he Testatrix a�d witneeses, xespectively whoae names are signec� �.a the �oregoing ar attached instrument, being first du7.y swo�n, do hereby declare to the unders�.gned I authori�y that the Teg�atrix �igned and exacuted the in�txument � __. ... . . ...._.. _ _ _ ... _-.-_ . . as her Last Wil1 and Tastament and that act �or�theWpurposes an tihat executad as kzer free and voluntazy i � there.in expx'essed, and tha� each of the witnesse�, in t,he � presence and hearing of the xesi:atx�i�c signed the Wi11 as � witnesses and tha� to the b�st of theiy knowledge the��Te�o�n�rix waa at '�he time eighteen (18} or more ea�s of a9�� • mi�.d and under no constxaint or undue in�luen.ce. � �.. ��0 � �mma R. Gate� � ��,."�"" � •��.�^' . . . f, , 'tne�s � ,W�.tness Sub�cxib�d, �worn Co and aCknaw7.edged be�ore me by �mma R. '; Gates, the Test trix, and �ubacribed ta an.d �wor�ar af�irmed� ta ' ,,y� ' and �Cllz�/1 �� be�ore me by „91�J1�� //� o f ��' 2003. . witne�aes, tliis �__ , � , • , � � • , , • � ' , tary Public � i ' . . ; i i . �Se�l tibUo gat}�a Allshou��be and Couniy � SAIDI9� � Caruste�o�, . ._ . y,�y Commisalon�XPires Mar�29,2004 ; s�r�,rr�ovvEx . . . . __. . . � i . �&LINDSAY . . nTron `��w � � .. 26 W.H1gh Street • ' , ' Carlisle,PA , ' . �I . i • � .. � • � i . • i " � • j J . i . ' 1 . . � .«._... � ...T..---...._..---. .,_..._ . i . ,. ...._._..____�" '� --"y' ^'__'..._._"_ I