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Home My WebLink About05-01-14 (2) 1505610101 REV-1500 Ex(01-10) PA Department of Revenue pennsylvanla OFFICIAL USE ONLY Bureau of Individuat Taxes County Code Year File Number PO BOX 280601 a INHERITANCE TAX RETURN f t _ Harrisburg,PA 17t28-0601 RESIDENT DECEDENT 14 `1 1PS ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDyYyY 03/31/2014 01106/1916 Decedent's Last Name Suffix Decedent's First Name MI WORATYLA ANNA H (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 Cb 1.Original Return I= 2.Supplemental Return q 3. Remainder Return(date of death prior to 12-13-82) O 4.Limited Estate t= 48.Future Interest Compromise(date of C= S. Federal Estate Tax Return Required death after 12.12-82) C=:) 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) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death q 11. Election to tax under Sec.9113(A) between 12-31.91 and 1-1.95) (Attach Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES M. BACH,ATTORNEY (717) 737-2033 REGISTER OF WILLS USE OgY T'r1 First fine of address r _ 7 a 352 S. SPORTING HILL RD I r'1 n a nr nt:r Second line of address CJ t7 <> -TT 11 -ri EO1 n rFIL City or Post Office Stele ZIP Code DATE >^y MECHANICSBURG PA 17050 —mot t—� mo Correspondent's o-mall address: STAFF@JAMESMSACH.COM Under penalties of perjury.I declare that I have examined this retum,including aocompanytng schedules and statements,and to the best of my knowledge and belief, It is"o,cloned and complete.Dadaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE 1 RESpOy6i8j.E F,OR FI RN pM ADDRES 439 E. CRESTWOOD DR., CAMP f ILL, PA 17011 SIGNATURE OF PREP ER OT R THAN RE N TIVE DATE ADQ§EqS 3$,S. SPORTING HILL RD, MECHAN SBURG, PA 17050 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 ..I 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: WORATYLA ANNA H. RECAPITULATION 1. Real Estate(Schedule A). . ...................... ................. . ... 1, 2. Stocks and Bonds(Schedule B) ...... ......... ............... ..... .... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorshlp(Schedule C) ..... 3, 4. Mortgages and Notes Receivable(Schedule D).. . .................. ..... 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... .... 6, 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 83,209.80 (Schedule G) O Separate Billing Requested........ 7, 8. Total Gross Assets(total Lines 1 through 7). ......... . .. ... """" 6' 83,209.80 9. Funeral Expenses and Administrative Costs(Schedule H)... ... "" 9' 16,885.26 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. ............ 10, 11. Total Deductions(total Lines 9 and 10).... ....... ...................... 11. 12. Net Value of Estate(Line 8 minus Line 11) . ......... � - 13. Charitable and Governmental Bequests/See 9113 Trusts for which 12 16,885.26 66,324.54 an election to tax has not been made(Schedule J) ................. . ...... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) ........ ta. 66,324.54 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_ 16. Amount of Line 14 taxable 15. at lineal rate X.0 45 17. Amount of Line 14 taxable 16' 2,984.60 at sibling rate X.12 18. Amount of Line 14 taxable 17. at collateral rate X.15 18. 19. TAX DUE ... .. . ........ ......... . ....... . ................. ... ... .. 19. 2,984.60 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O !_ Side 2 1505610105 1505610105 J REV0500 FCC Page 3 File Number Decedent's Complete Address: DECEDENTS NAME ANNA H.WORATYLA STREETADDRESS 439 EAST CRESTWOOD DRIVE CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 0) 2,984.60 2. CreditslPayments A.Prior Payments B.Discount 0.05 Total Credits(A+B) (2) 149.23 3. Interest (3) 4. If tine 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. It Line 1 +Line 3 is greater than Line 2,enter the difference,This is the TAX DUE. {5} 2,83537 r✓ Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;......... ...... ............................ ...... ❑ Q' b. retain the right to designate who shall use the property transferred or its income,....._.................................... ❑ Q c. retain a reversionary interest;or.......................................................................................................................... d. receive the promise for life of either payments,benefits or pre?...................................................................... ❑ 2. If death occurred after Dec.12,1962,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 amount or security at his or her death?.............. ❑ El 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 Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan, 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary, For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent(72 F.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, 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 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-i5o9 EX+(OT-io) t7j j pennsytvania SCHEDULE F DEVARTANCE TA RETURN JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WORATYLA,ANNA H. 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.JOHN A.WORATYLA 439 EAST CRESTWOOD DRIVE SON CAMP HILL, PA 17011 'ACCOUNTS HAVE BEEN JOINT IN EXCESS OF 15 YEARS' B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACK DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 01161199 PNC MONEY MARKET ACCT(51-3012.7603) 153,200.03 501/o 76,600.01 2 A 01/01/99 PNC CHECKING ACCT(51.4007-0464) 13,219,57 501/6 6,609.79 TOTAL(Also enter on Line 6, Recapitulation) $ 63.209.84 If more space Is needed,use additional sheets of paper of the same size. . 4V-1511 EX+ (10-09) 1--"' pennsYtvania SCHEDULE H DEPARTMENT OF REVENUE INHERITANCE TAX REruRN FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF V/ORATYLA, ANNA H. FILE NUMBER ITEM Decedent's debts must be reported on schedule I. NUMBER A. FUNERAL EXPENSES: DESCRIPTION 1. DAILY FUNERAL HOME,HARRISBURG,PA AMOUNT 2. SARA A.TODD NURSING HOME 10,663.77 1,111.00 B. ADMINISTRATIVE COSTS: 1• Personal Representative Commissions: Name(s)of Personal Representative(s) JOHN A. WORATYLA 4,160.49 Street Address 439 EAST CRESTWOOD DRIVE city. CAMP HILL Year(s)Commission Paid: 2015 State PA zip 1701_ Z. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 950.00 Claimant Street Address City Relationship of Claimant to Decedent State_ZIp 4. Probate Fees: 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 0.00 7. 0.00 TOTAL(Also enter on Line 9, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. 16,885.26