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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
REV-1500
OFFICIAL USE ONLY
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DATE OF DEATH (MM-DD-YEAR)
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUNTY COOE YEAR
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NUMBER
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-YEAR)
NAME
Anthony L. DeLuca,
01-27-05 11-18-12
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
D 4. Limited Estate
[X] 6. Decedent Died Testate (Allacl1 copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death afler 12.12-62)
D 7. Decedent Maintained a Living Trust (Atlacl1 copy of Trusl)
D 10. Spousal Poverty Credit (dale of death between 12--31.91 and 1.1-95)
D 3. Remainder Return (date of death prior to 12.13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Atlacl1 Scl1 0)
1. Real Estate (Schedule A) (1) -0-
2. Stocks and Bonds (Schedule B) (2) 12,607.91
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) -0-
4. Mortgages & Notes Receivable (Schedule D) (4) -0-
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2,746.46
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6) -0-
~ D Separate Billing Requested
..J (7) -0-
::::>> 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
I- (Schedule G or L)
0: 8. Total Gross Assets (total Lines 1-7)
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() 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2,112.11
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~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 7,322.51
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-?SA-fiR44
COMPLETE MAILING ADDRESS
113 Front street
P.O. Box 358
Boiling Springs,
PA
17007
Esquire
OFFICIAL USE ONLY
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(8) 1 5 , 3 5 4 . 3 7
(11) 9,434.62
(12) 5,919.75
(13) -0-
(14) 5,919.75
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
5,919.75
x.O_ (15) -0-
x.O_ (16) 0
x .12 (17) -O-
x .15 (18) 887.96
887.96
(19)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at Jinealrate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS 801 N. Hanover street
CITY Carlisle, I STATE PA I ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
887.96
-0-
-0-
-0-
Total Credits ( A + B + C ) (2)
-0-
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
(3)
(4)
(5)
(5A)
33.65
-0-
4.
10tallnteresUPenalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT;
Check box on Page 1 Line 20 to request a refund
33.65
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
887.96
A. Enter the interest on the tax due.
33.65
921.61
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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
a. retain the use or income of the property transferred; .......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
No
[Xl
IX]
IX]
IX]
IX]
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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.
Oecl ation of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI N URE OF PERSON RE
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DATE
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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 3%
[72 P.S. S9116 (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% [72 P.S. S9116 (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 twenty-one 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% [72 P.S. S9116(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%, except as noted in 72 P.S. S9116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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.
R':Y-1502 EX+ (12-85)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FilE NUMBER
ESTATE OF
Martha T. Worley
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported ot fair market value
which is defined os the price at which property would be exchanged between 0 willing buyer and a willing seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
NUIT~~ER I DESCRIPTION VALUE AT DATE
OF DEATH
1.
NONE
-0-
- .
TOT At (Also enter on line 1, Recapitulation)
111 """""'0 c,.,,.,,..Q ;c n,::u::I,,..J~rI, ;nl;;prl nrlriitional ~},aefs of .same sizeJ
$
-0-
REV-IS03 EX + (4-861
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COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS AND BONDS
ESTATE OF
FILE NUMBER
Martha T. Worley
(All property jointly-owned with Right of Survivorship must be disclosed on Schedulo F.)
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
740.499 shares of Van ~ampen US Mortgage Fund
Class A @$13.94 per share
$10,322.56
2.
280.0680 shares of Delaware Tax-Free Pennsylvania
Fund A @$8.16 per share.
2,285.35
;,
TOTAL (Also enter on line 2, Recapitulation)
S 12,607.91
R EV.1504 EX + /1.921 . ~
~~.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
Please Print or Type
FILE NUMBER
ESTATE OF
Martha T. Worley
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
NONE
-0-
TOTAL (Also enter on line 3, Recapitulation) S
-0-
(If more space is needed, insert additional sheets of same size.)
REV-1507 EX+ (7-88)
'*
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
Please Print or Type
I FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Martha T. Worley
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F.)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
NONE
-0-
:@IJp .,.,
TOTAL (Also enter on line 4, Recapitulation) $ - 0-
(If more space is needed, insert additional sheets of same size.)
REV. 1508 EX + 11.871
.
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Martha T. Worley
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1 .
Checking account, #604828, at M&T Bank
$2,746.46
TOTAL (Also enter on line 5, Recapitulation) S 2, 746.46
(Attach additional BY," X 11" sheets if mare space is needed.)
~ev:.1509 EX. (12.881 ~Ac
~
COMMONWEALIH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
Martha T. Worley
I FILS NUM~ER
ESTATE OF
Joiot tencnt(5):
NAME
ADDRESS
RELATlONSHIP TO DECEDENT
A.
NONE
B.
c.
Jointly-owned property:
ITEM
NUMBE::IJ
I
1. I
i
LETTER
F.OR
JOINT
TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
TOTAL VALUE
OF ASSET
DECO'S
% INT.
DOLLAR VALUE OF
DECEDENT'S INTEREST
TOTAL (Also enter on line 6, Recapitulation)
(If morespcce is needed insert additional sheels of same size)
$
o
REY.1511 EX + (7.SS)
ESTATE OF
ITEM
NUMBER
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMONWEALTH OF PENNSYLVANIA
. INHERITANcE TAX-RETURN
RESIl'leNT l'lEeEPENT
Please Print or Type
FILE NUMBER
Martha T. Worley
DESCRIPTION
A. Funeral Expenses:
1.
B.
1.
2.
Administrative Costs:
Patricia A. Fry
Personal Representative Commissions Shirley Lippe
Social Security Number of Personal Representative:
2006
Year Commissions paid
Attorney Fees Anthony L. DeLuca, Esquire
3. Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
Relationship
City
State
Zip Code
Probate Fees
Miscellaneous Expenses:
Legal Advertising - Cumberland Law Journal
Legal Advertising - The Sentinel
Filing Fees for Inheritance Tax and Inventory
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of same sixe.)
AMOUNT
384.00
384.00
900.00
144.00
75.00
195.11
30.00
$ 2,112.11
EV.151~ EX+ (9-81)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE "1"
DEBTS OF DECEDENT,
MORTGAGES, AND LIENS
FILE NUMBER
Martha T. Worley
ITEM
NUMBER DESCRIPTION
AMOUNT
1. Church of God Home - Nursing Home Bill
246.64
2. Department of Public Welfare
Estate Recovery Program - Claim
6,984.81
3. Three Springs Family Practive - Medical
91.06
TOTAL (Also enter on line 10, Recapitulation)
$
7,322.51
REv.1S1J EX+ \2.87)
'*'
COMMONWEALTH OF P~NNSYLVANI'"
INHERITANCI TAX RETURN
RES1DliNT DECEDENT
SCHED'ULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
ITEM
NUMBER
1.
2.
Martha T. Worley
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests;
Susan Weibley
132 Elm Street
Carlisle, PA 17013
Niece
one-sixth
Patricia A. Fry
411 Walnut Street
Boiling Springs, PA 17007
Niece
One-Sixth
3.
Susan Souder
115 Crosspointe Drive
West Chester, PA 19380
Niece
One-Sixtn
4.
Virginia Stone
1129 Redwood Drive
Carlisle, PA 17013
Niece
One-Sixth
5.
Shirley Lippert
12 Carlton Avenue
Carlisle, PA 17013
Niece
One Sixth
6.
Vonnie McGuire
3 Limestone Drive
Mechanicsburg, PA 17055
Niece
One-Sixth
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
1.
B, Charitable and.Governmentol Bequests;
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS {Also enter on line 13, Recopitulotion) S
(If more space is needed, insert additional sheets of same size)
LAST WILL AND TESTAMENT OF MARTHA T. ~ORLEY
I, MARTHA T. WORLEY, of the Borough of Carlisle, Cumberland
County, Pennsylvania, declare this instrument to be my LastWill
and Testament, in manner and form following:
1. I hereby expressly revoke all Wills and Codicils
heretofore made by me.
2. I hereby direct my Executrices to pay all my just
debts, funeral and administrative expenses out of my estate, as
soon as practicable after my death.
3. I direct that all taxes that may be assessed in
consequence of my death of whatever nature and by whatever
jurisdiction imposed shall be paid out of my estate as a part of
the administration of my estate.
4. I give and bequeath my diamond ring to my niece, Susan
Souder, provided she survives my death.
'//5. I gi ve and bequeath the diamond pendant, which
incorporates the diamond which had belonged to my late husband,
Levi William Worley, to my niece, Patricia A. Fry, provided she
survives my death.
1 / 6. I gi ve and be.qy;~~~th.rny Susan
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Souder and Patricia A. Fry, or the survivor of them if one is not
living at the time of my death, to be divided between them in
approximately equal shares as they may agree.
1
7 . I give , devise and bequeath tlier"enlaThtl er of my estate
of every nature and wherever situate in equal shares unto my six
nieces, to wit: Susan Worley, Patricia A. Fry, Susan Souder,
Virginia Wilson Downey, Shirley Lippert and Vonnie Tanger Brandt.
Should any of said nieces predecease me, the share of such
deceased niece shall be distributed equally to the shares of
those nieces who do survive my death.
8. I nominate and appoint my nieces, Patricia A. Fry and
Shirley Lippert,as,E:X'~~;
Testament. Should either of said nieces fail to qualify or cease
to serve as an Executrix, the other shall serve in such capacity
as sole Executrix.
9. I direct that my personal representatives shall serve
as such without the necessity of filing bond or security in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this
l?!(
day of February, 1987.
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Martha T. Worley
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WITNESS:
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COUNTY OF CUMBERLAND
I, Martha T. Worley, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by Martha
T. Worley, Testatrix, this (8{.A, day of February, 1987.
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ME~lENE MARHEYKA, Notary Public
((ub;.', Cumb8r\and (oun:y, Po.
My Commission Expires (, / -7 je} c;
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We, Roger M. Morgenthal and {) (--.L~.~:<-t~,c" , the
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw Testatrix, Martha T. Worley,
sign and execute the instrument as her Last Will; that she signed
willingly and that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the
hearing and sight of the Testatrix signed the Will as witnesses;
and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
February, 1981.
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Witness -
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MERLENE MAHI-1EVIC6.., Notary Public
COllisl", Cumbu!a"d Couniy, Po. .
My Commis"ion Expires i.(.' /-/(1 <) ~
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