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Home My WebLink About05-10-1015056041114 --~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN , / p PO Box 2sosol ~ ~ f o 0`7'd s Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204-72-4791 02042010 09181991 Decedent's Last Name Suffix Decedent's First Name MI BRICKNER NATHAN A (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 1. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate 1-ax Return Required death after 12-12-82) 0 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death ~ 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 T0: Name Daytime Telephone Number CHARLES R. NEBEL, CPA Firm Name (If Applicable) BOYER & RITTER CPAS First line of address 141 WEST HIGH STREET Second line of address City or Post Office CARLISLE 717-249-3414 REGISTER OF WILLS USE ONLY r4.a .::s _ ;s. r~ -.~ ~ ~ ~; f ~ - ~ .. ~~ --~ d :Y ti~. ~ ^ ~~ED ` f~~:~ ` ~~ ~ State ZIP Code , , PA 17 013 ---, ~ ~ ~-~~ - i " ,» ~,. ..... ~ Y Correspondent's a-mail address: CNEBELC~CPABR . COM ''~ Under penalties o perjury, I ec are that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belie , it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILIN RETURN DATE ADDRESS 29 HICKOR TOWN ROAD, CARLISLE, PA 17015 SIG~E OF PRE~~HE~HAN RE~S~AT~~ , DATE ~+fDDRESS / ~ BOYER & RITTER, CPAS, 141 WEST HIGH STREET, CARLISLE, PA 1^1013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041114 15056041114 J J 15056042115 REV-1500 EX Decedent's Name: NATHAN A B R I C KN E R Decedent's Social Security Number 204-72-4791 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages 8~ Notes Receivable (Schedule D) ............................ 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ........ 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ....... . 7. NONE 8. Total Gross Assets (total Lines 1-7) .................................. 8. 5850.00 3556.00 9406.00 9. Funeral Expenses & Administrative Costs (Schedule H) ................... 9. NONE 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. NONE 11. Total Deductions (total Lines 9 8 10) ................................. 11. O . O 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 9 4 O 6 . 0 O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... .. 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ..... 14 9 4 0 6. 0 0 TAX COMPUTATION -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 0 9 4 0 6. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 O 19. TAX DUE ....................................................... 19. 0 . O O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 15056042115 15056042115 J REV-1500 EX Page 3 204-72-4791 Decedent's Complete Address: DECEDENT'S NAME IATHAN A BRICKNER STREET ADDRESS 9 HICKORYTOWN RC CITY ISLE Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty File Number DECEDENT'S SOCIAL SECURITY NUMBER 204-72-4791 STATE xlp PA 1701 (1) 0.00 Total Credits (A + B + C) (2) 0.00 Total Interest/Penalty (D + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) _ Make Check Payable to: REG/STER OF W/LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred : ....................................... Yes No b. retain the right to designate who shall use the property transferred or its income : ................ c. retain a reversionary interest; or .......................................... . ........... ^ a d. receive the promise for life of either payments, benefits or care? ............................. ~ a 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? .. ~ 0 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 PA RT OF THE RETURN. For dates of death on or after July 1, 1994 and before Janua 1, ry 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (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 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 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 0.00 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COM NHERITANCEOTAX RETURNANIA PERSONAL PROPERTY RESIDENT DECEDENT ESTATE A~ FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All roe 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 YAMAHA 250 OFF ROAD CYCLE OF DEATH 2 1995 FORD MUSTANG SEDAN -ENGINE BLOWN 700 3 1997 FORD F250 4X4 TRUCK, 185,000 MILES -POOR CONDITION 1,000 4 16 FOOT TRAILER 1,200 5 YAMAHA 4 WHEELER 2,000 950 TOTAL (Also enter on line 5, Recapitulation) $ (If more space Is needed, Insert addltlonal sheets of the same size) 5,850 REV-1509 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT CCTATC nr. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER: NATHAN A. BRICKNER 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. JONI K. BRICKNER 29 HICKORYTOWN ROAD, CARLISLE, PA 17013 MOTHER B C JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT NUMBER TENANT ~ A MADE JOINT INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY HELD REAL ESTATE. MEMBERS 1ST SAVINGS ACCOUNT DATE OF DEATH VALUE OF ASSET DECEDENTS DA VA UE OF TH INTEREST DECEDENTS INTEREST 1~1~92 7,112 50.00% 3,556 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 6, Recapitulation) I 3 If more space Is needed, use addltlonal sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NATHAN A. BRICKNER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1 BARRY R. AND JONI K. BRICKNER 29 HICKORYTOWN ROAD, CARLISLE, PA 17013 PARENTS o 100 /o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0 If more space is needed, use additional sheets of paper of the same size. t,~. ~ ~! ~.~..t~ ~ I ~F ~: . NO ~~ ~"' kW, ..,. Y ~ .I 4 j + a P '~ r~. ~ ~' y~ l V ~- ~ -' ~ _ ~ o 4- cv ~ O n _ rt ~ ~ O - C (~D i~~~ ~~ ~ ~~ .j ~ >>~~~