HomeMy WebLinkAbout04-07-10_1 REV-1500 1505607120
PA Department of Revenue
Bureau of Individual Taxes EX (06.05)
OFFICIAL USE ONLY
c
PO Box.2soso7 ounty code Year
INHERITANCE TAX RETURN File Number
Harrisburg, PA 17128-0607
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT 21 0 9
0 9 2 6
Social Security Number Date of Death
Date of Birth
247013401 08202009
Decedent's Last Name 06211915
WORRELL Suffix Decedent's First Name
MI
THOMAS
(If Applicable) Enter Surviving Spouse's Information Below A
Spouse's Last Name
Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FIL REGISTER OF WILLS
L IN APPROPRIATE OVALS BELOW
® 1. Original Return
^
2. Supplemental Return
^ 3. Remainder Return (date of death
^ 4. Limited Estate
^ prior to 12-13-82)
4a. Future Interest Compromise
® g. Decedent Died Testate (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
(Attach Copy of Will) ^ 7. Decedent Maintained a Living Trust
(Attach Copy of Trust) 8. Total Number of Safe Deposit Boxe
^ 9. Litigation Proceeds Received ^
1 p Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) s
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFID
Name
FRANCIS A Z UL L I ENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Numbe
r
Firm Name (If Applicable) 717 2 3 214 8 8
WION, ZULLI AND SEIBERT REGISTERO
~'~/ILLS USE ~y
First line of address ~Q o ,;;-~
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109 LOCUST STREET ~'rn- ~
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Second line of address z
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City or Post Office ~?
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HARRISBURG State D~~ED '--
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PA 17101
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Correspondent'se-mail address: WZS@m7ndS rln
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Under penalties of perjury, I declare thaYl have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, co.~rect and complete. Declaration of preparer other thyyyar/the personal representative is based on all information of which preparer has any knowledge.
SIGNAT~;=`OF,rPjERSpN RESPONSI LE FO FILING RETURN f '
,::~',~J r~i~~'i.C1 ~'~~ ? ~ DATE
4[$DRES§"~ ~`~~ ~ ~ Preston A. Worrell ~._,__ e--- _ ~
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15D56D712D
Side 1
1505607120 J (`~ ,
ADDITIONAL Personal Representatives
Worrell, Thomas A SS# 247-01-3401 8/20/2009
Under penalties of perjury, the undersigned declare that they have examined this return,
including accompanying schedules and statements, and to the best of their knowledge and
belief, it is true, correct and complete.
2 Signature
Name
Address
City, State, Zip
Date
3 Signature
Name
Address
City, State, Zip
Date
4 Signature
Name
Address:
City, State, Zip
Date
5 Signature
Name
Address:
City, State, Zip
Date
6 Signature
Name
Address:
:~
:`
a:
/'~- W
Thomas A. Worrell
138 Yellow Breeches Drive
Camp Hill PA 17011
3~.~ - ICS
City, State, Zip
Date
.J
1505607220
REV-1500 EX
Decedent's Social Security Number
DecedenYsName: WORRELL, THOMAS A 2 4 7 013 4 01
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
2 4, 3 5 6. 4 5
2.
.......................................
Stocks and Bonds (Schedule B) ........................................
.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 1 9 , 9 2 5 . 9 9
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
^ Separate Billing Requested .............
7. g 2 g 4 . 0 5
~
(Schedule G)
g. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 3 3, 5 6 6. 4 9
9 10 , 8 61.0 0
9.
........................
Funeral Expenses & Administrative Costs (Schedule H) .................
.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
2,167.20
11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 1 3 , 0 2 8 . 2 0
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 2 O , 5 3 8 . 2 9
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. 2 0 , 5 3 8 . 2 9
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15.
(a)(1.2) X .00
16. Amount of Line 14 taxable 2 0 5 3 8. 2 9
045 16. 9 2 4. 2 2
r
at lineal rate X .
17. Amount of Line 14 taxable
1 ~~
at sibling rate X .12
18. Amount of Line 14 taxable
18.
at collateral rate X .15
19. Tax Due ..................................................................................................................... 19- 9 2 4. 2 2
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505607220 1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
Worrell, Thomas A
527 9th Street
File Number 21 - 09 - 0926
STATE ZIP
pq 17070
New Cumberland
Tax Payments and Credits: (1) 924.22
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.
3. Interest/Penalty if applicable
p, Interest
E. Penalty " 0.00
Total Interest/Penalty (D + E) (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 924.22
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
(5A)
A, Enter the interest on the tax due.
(56) 9 2 4.2 2
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable fo: REGISTER OF WILLS, AGENT
~,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
1. Did decedent make a transfer and:
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 ..................................................................................................................
..................................... ^ 0
d. receive the promise for life of either payments, benefits or care? ........................ .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^
.................................................................... .
receiving adequate consideration .........................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^
contains a beneficiary designation? ............................... .. .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after J 1n1 ary 1, The statute doesenot exempt a t ansfer to a surv v ng spouser from taxsand the stat ft ry quirementsro
(0) percent (72 P.S. §9116 (a) ( ) (~~)l•
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use o a
natural parent, an adoptive parent, or a stepparent of the child is zero (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 four and one-half (4.5) percent,
except 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 twelve (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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
ESTATE OF Worrell, Thomas A 21 - 09 - 0926
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 US Savings Bonds (See attached list) 4,356.45
TOTAL (Also enter on line 2, Recapitulation) 4,356.45
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Worrell, Thomas A 21 - 09 - 0926
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 DESCRIPTION :VALUE AT DATE OF
NUMBER DEATH
1 PNC Bank Savings Account No. 5003537455 16,133.68
Accrued Interest 1.35
2 Refund from USAA Insurance 1,802.40
3 Refund 133.56
4 1997 Buick 1,855.00
I TOTAL (Also enter on Line 5, Recapitulation) I 19,925.99
~~
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Worrell, Thomas A
FILE NUMBER
21 - 09 - 0926
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is ves.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent
and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH
VALUE OF ASSET ~ OF
DECD'S
INTEREST EXCLUSION
(IF APPLICABLE)
TAXABLE VALUE
1 PNCChecking Account No. 5140070521 12,283.57 3,000.00 9,283.57
Accrued Interest 0.48 0.48
TOTAL (Also enter on line 7, Recapitulation) 9,284.05
SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN A~'N~QTr~~T\/~' /'~nCTe
RESIDENT DECEDENT w ~ ~ v-u ~ r ~. vvv ~ ~7
FILE NUMBER
ESTATE OF Worrell, Thomas A 21 - 09 - 0926
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Stone and Murray Funeral Home -Funeral Services 6,505.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Wion, Zulli and Seibert -- Francis A Zulli
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Preston A. Worrell
Street Address 527 9th Street
city New Cumberland state PA zip 17070
Relationship of Claimant to Decedent SOn
4. Probate Fees Register of Wills
Short Certificate
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1
750.00
3,500.00
102.00
4.00
TOTAL (Also enter on line 9, Recapitulation) 10,861.00
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Worrell, Thomas A
FILE NUMBER
21 - 09 - 0926
Include unreimbursed medical expenses.
ITEM
NUMBER
1 ~; Claremont Nursing Home
2 ~. PharMerica -Medicine
3 ~ PharMerica -Medicine
DESCRIPTION ~ AMOUNT
2,160.00
3.62
3.58
TOTAL (Also enter on Line 10, Recapitulation) ( 2,167.20
REV-1513 EX+ (9-00) ~
SCHEDULE)
COMMOERI ANC OAXRE URNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
Worrell, Thomas A FILE NUMBER
21 - 09 - 0926
NUMBER
NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I, TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Preston A. Worrell Son Automobile and 1/2
527 9th Street of Residue
New Cumberland, PA 17070
2 Thomas A. Worrell Son 1/2 of Residue
138 Yellow Breeches Drive
Camp Hill, PA 17011
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
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L_ --- c_~=~'~' - OF
:::_ ;__: •._ ~ =T = ' THOMAS A. WORRELL
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-- ~ l~-F~,' OMAS A. WORRELL, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this to be my Last Will and Testament hereby revoking all
other Wills and Codicils by me at any time heretofore made.
ITEM I: I direct that all of my just debts and currently due debts and
?~~ funeral expenses shall be paid from my estate as soon as practicable after my decease as a
~' part of the expense of the administration of my estate.
r
= ITEM II: I give and bequeath my 1988 Cadillac automobile to my son,
THOMAS A. WORRELL.
v ITEM III: I give and ben~~eath a1 o_f my household goods, automobiles
aJ
9~ and all other articles of household and personal use, tools, equipment and similar items to
U
my son, PRESTON A. WORRELL.
1
~ ITEM N: I give and devise my real estate known and numbered as 527
~J Ninth Street, New Cumberland, Cumberland County, Pennsylvania, to my son,
PRESTON A. WORRELL, only if he survives me.
ITEM V: I give, devise and bequeath all of the rest, residue and
remainder of my estate, whether real or personal, or wheresoever the same maybe situate
or located, in equal shares, to my sons, THOMAS A. WORRELL and PRESTON A.
VJORRELL, per stirpes.
ITEM VI: I norninate, constitute and appoint my sons, THOMAS A.
WORRELL and PRESTON A. WORRELL, as Co-Executors of this my Last Will and
Testament.
ITEM VII: It is hereby directed that my Co-Executors shall pay all
inheritance, estate, succession and legacy taxes to which my estate for the transfer of any
property hereunder maybe subject, and to charge such taxes as a part of the expense of
the administration, payable out of my residuary estate.
ITEM VIII: I direct that no Co-Executors or other fiduciary named,
nominated or appointed in this my Last Will and Testament sb.all be required to post any
bond or give any security of any type for any purpose whatsoever, any law or rule of the
Court cf the Commonwealth of Pennsylvania or any other jurisdiction to the contrary
notwithstanding.
IiV WITNESS WHEREOF, I have hereunto set my hand and seal this ~~~~~~ day
~~,
of ._..~i~t, ~t~~ , 1998.
/ ~--- -~,
Thomas A. Worrell
Signed, sealed, published and declared by the said Thomas A. Worrell, the above
named Testator, as and for his Last Will and Testament, in the presence of us, who at his
request and in his prese~ice and in the presence of each other, all being present at the
same e have hereunto subscribed our names as witnesses hereto.
~ ,~~~ ~~ ~ ~~ 1
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~~~~ ~ .~~,` ~~.~i` Residing ~~~l:t.~;~'~ ~~/ .~ ~.~.~~,-~ ~..,
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~`7~ .1_j(~~~C!~.L~,~ Residing ~~--~!~~'~ r'~~ r~~
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COMNI:ONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, THOMAS A. WOI~RELL, Francis A. Zulli and Wendy S. Paul, the Testator and
the witnesses respectively, whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do hereby declare to the undersigned
authority that we were present and saw Testator sign an4 execute the instrument as his
Last Will, that he signed willingly (or willingly directed anot'rer to sign for him), and that
he executed it as his free and voluntary act for the purposes therein expressed; that each
of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses;
and that to the best of our knowledge the Testator was at that time eighteen (18) or more
years of age, of sound mind and under no constraint or undue influence, and I, the said
Testator, do hereby acknowledge that I signed and executed the instrument as my Last
Will and Testament, that I signed it willingly, and that I signed it as my free and
voluntary act for the purposes therein expressed. c-----._,,,
T ~'fATOR ~ ~ ~ ~
~ _ ~ `r
/ WITNESS ~
Subscribed, sworn to and
acknowledged before me by
Thomas A. Worrell, the Testator,
and subscribed and sworn to
before me by Francis A. Zulli
and Wendy S. Paul,
witnesses, this ~'~~' day of
Tune, 1 ~9 ~~ ~-
Notary Publi~._.i~
NGTARI~L SRAL
APiN J. LCP;u, Pieta, ~ °ublic
City of Harrisburg, D~±p1Un County
f;2V C~mmisc+on Exprns Oct 30. t ~3