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Home My WebLink About04-19-13 REV-1500 EX(02-11) 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60x.280601 INHERITANCE TAX RETURN 21 12 1155 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08 12 2010 09 13 1931 Decedent's Last Name Suffix Decedent's First Name MI BRICKER CLARENCE 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 2. Supplemental Return �] 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise 7 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Dece 8. Total Number of Safe Deposit Boxes dent Died Testate Decedent Maintained a Living Trust (Attach Copy of Will) ❑ (Attach Copy of Trust) P 9. Litigation Proceeds Received 10.Spousal Poverty Credit(Date of Death �] 11.Election to tax under Sec.9113(A) between 12-31-'91 and t-1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK A MATEYA 71P 241 X00: ca 17.11 n Ri6dliYE@2 PF WIXJLS USE ONLY L J First Line of Address 55 W CHURCH AVENUE r - _ 7 2 Second Line of Address j ry - M c :n ca City or Post Office State ZIP Code DATEtZF3LED CARLISLE PA 17013 Correspondent's e-mail address: marl @mateyalaW.com 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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT OF PERSON RESPONSIB FO FILING RETURN DATE Janet K Bricker Lj & ADDRE 4 Abbey Court Carlisle PA 17015 4— —)_3 SIGNATUR O ESENTATIVE DATE A Mark A. Mateya ADDRESS 55 W. Church Avenue, Carlisle, PA Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Bricker, ClarenceA RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)................................................ .......................... 2. 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. 341 . 93 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nnq-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 125 ,377 . 86 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 125,719 . 79 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 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).......................................................... 12. 125, 719 . 79 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. 125,719 . 79 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.00 341 . 93 15. 0 . 00 16. AmountX .0 taxable at lineal rate 45 rate e X .0 125 r 377 . 86 16. 5 , 642 . 00 i 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 5 , 642 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12-1155 Decedent's Complete Address: DECEDENT'S NAME Bricker, Clarence A STREET ADDRESS 231 Pine Road CITY Mount Holly Springs STATE ZIP 17065 Tax Payments and Credits: I- Tax Due(Page 2,Line 19) 5,642.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +13) (2) 0.00 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 I +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 5,642.00 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;.............. .................................... FAJ 1:1 b. retain the right to designate who shall use the property transferred or its income;...... ..................... ..... ❑ I-XI c. retain a reversionary interest;or.... ......................__........__........- 17 FX] d. receive the promise for life of either payments,benefits or care?.... ................. ................ ................... L] EXI 2- If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?........_........................ .......... ........ ........ Ll 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?............. ........... ........... .......... .........__...................... ....-....... E-1 1 7X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. �Wl 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 [72P.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 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 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 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. M - Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Bricker, Clarence A 21-12-1155 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 Members 1st Federal Credit Union-Savings Account No. 34984-000 341.93 TOTAL(Also enter on Line 5, Recapitulation) 341.93 (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 E(Rev. 11-10) Rev-1510 EX-(08.09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Bricker, Clarence A 21-12-1155 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DA E NAME TRANSFER. ATTACH A COPYEOF RELATIONSHIP DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST" (IF APPLICABLE) VALUE 1 Real Estate-10199 Creek Road, Perry County-Parcel 126,066.68 66.667% 6,000.00 78,044.50 Identifier 100,056.00-023.000 Assessed value-See attached; conveyed decedent's 1/2 share to two daughters within one year of date of death 2 Real Estate-10199 Creek Road, Perry County-Parcel 71,000.00 66.667% 47,333.36 Identifier 260,056.00-023.003 Assessed value-See attached ; decedent conveyed his one-half share to two daughters within one year of date of death TOTAL(Also enter on Line 7, Recapitulation) 125,377.86 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev. 08-09) PERRY COUNTY ASSESSMENT OFFICE Perry County Board of Assessment Appeals 25 WEST MAIN STREET Brenda L. Benner, Commissioner PO BOX 37 Paul L. Rudy, Commissioner NEW BLOOMFIELD PA 17068 Stephen C. Naylor, Commissioner (717) 582-2131, ext. 4119 William R. Bunt, Solicitor Hours: 8:00 am to 4:00 pm weekdays Randy Waggoner, Chief Assessor BRICKER, JANET K ET AL Parcel Identifier: & MELANIE ANN WERTZ & TAMMY 100,056.00-023.000 LEE KARSTETTER 231 PINE ROAD MAILING DATE: JULY 26, 2012 MT HOLLY SPRINGS PA 17065 APPEAL DEADLINE: SEPTEMBER 04, 2012 CHANGE OF ASSESSMENT NOTICE -THIS IS NOT A TAX BILL This is a notice of a change in assessed valuation of an approved Clean and Green parcel. REASON FOR CHANGE: 40 - PA DEPT OF AG C&G REVISED RATES The new value is based on "use value" changes from the 'IPA Department of Agriculture" and MAY not reflect recent transfers of land, new construction, or alterations to structures. RIGHT To FORMAL APPEAL: If you disagree with the values, tax status, or C&G status on this notice, You may file a formal appeal with the Board of Assessment Appeals, in writing, within 40 days of the date of this notice. Appeals must be received at the address above by the deadline. FUTURE TAX BILLING BASIS EFFECTIVE: 01/01/2013 for County/Munic 07/01/2013 for School OLD NEW ASSESSMENT 96,400 96,600 TAX STATUS Taxable Taxable PROPERTY DESCRIPTION C&G STATUS Approved Approved Muni c. : 10 - JUNIATA TOWNSHIP School: 4 - NEWPORT SD MARKET-BASED ASSESSMENT Control Number: 00507229 OLD NEW Land 131,500 131,500 Improvements 57,600 57,600 TOTAL 189,100 189,100 of Market Value at 2010 Base Year Rates. Property Location: 10199 CREEK ROAD CLEAN AND GREEN (C&G) ASSESSMENT OLD NEW Land Size: 56.20 acres Land 38,800 39,000 Improvements 57,600 57,600 TOTAL 96,400 96,600 Property Type: AS Land value based on rates provided by the State- seasonal-Used < 50% Of Year Perry County Board of Commissioners CHANGE OF TAX BASIS - NET CHANGE Brenda K. Benner, Chairman Stephen C. Naylor, vice-Chairman COUNTY/MUNIC SCHOOL Paul L. Rudy, Secretary Land 200 200 Improvements 0 0 TOTAL 200 200 [Effects Future Billing Cycles only (notc—alIL) ORIGINAL PERRY COUNTY ASSESSMENT OFFICE Perry County Board of Assessment Appeals 25 WEST MAIN STREET Brenda L. Benner, Commissioner PO BOX 37 Paul L. Rudy, Commissioner NEW BLOOMFIELD PA 17068 Stephen C. Naylor, Commissioner (717) 582-2131, ext. 4119 William R. Bunt, Solicitor Hours: 8:00 am to 4 :00 pm weekdays Randy Waggoner, Chief Assessor BRICKER, JANET K ET AL Parcel Identifier: & MELANIE ANN WERTZ & TAMMY 260,056.00-023.003 LEE KARSTETTER 231 PINE ROAD MAILING DATE: JULY 26, 2012 MT HOLLY SPRINGS PA 17065 APPEAL DEADLINE: SEPTEMBER 04, 2012 CHANGE OF ASSESSMENT NOTICE - THIS IS NOT A TAX BILL This is a notice of a change in assessed valuation of an approved Clean and Green parcel.. REASON FOR CHANGE: 40 - PA DEPT OF AG C&G REVISED RATES The new value is based on "use value" changes from the "PA Department of Agriculture" and MAY not reflect recent transfers of land, new construction, or alterations to structures. RIGHT TO FORMAL APPEAL: If you disagree with the values, tax status, or C&G status on this notice, you may file a formal appeal with the Board of Assessment Appeals, in writing, within 40 days of the date of this notice. Appeals must be received at the address above by the deadline. FUTURE TAX BILLING BASIS EFFECTIVE: 01/01/2013 for County/Munic 07/01/2013 for School OLD NEW ASSESSMENT 6,900 7,300 — TAX STATUS Taxable Taxable PROPERTY DESCRIPTION C&G STATUS Approved Approved Muni c : 26 - TUSCARORA TOWNSHIP School: 2 - GREENWOOD SD MARKET-BASED ASSESSMENT Control Number: 00519925 OLD NEW Land 106,500 106,500 Improvements 0 0 TOTAL 106,500 106,500 Property Location: 1000 of Market Value at 2010 Base Year Rates. 10199 BUFFALO TRACE CLEAN AND GREEN (C&G) ASSESSMENT PB 34-94 Unit/Lot ID: L-0003 OLD NEW Land Size: 54.20 acres Land 6, 900 7,300 Improvements 0 0 TOTAL 6, 900 7,300 Property Type: V Vacant Land Land value based on rates provided by the State. Perry County Board of Commissioners CHANGE OF TAX BASIS - NET CHANGE Brenda K. Benner, Chairman Stephen C. Naylor, Vice-Chairman COUNTY/MUNIC SCHOOL Paul L. Rudy, Secretary Land 400 400 Improvements 0 0 TOTAL 400 400 Effects Future Billing Cycles Only [notc_allL] ORIGINAL iii REV-1313 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Bricker, Clarence A 21-12-1155 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List TrustWsi TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Janet K Bricker Spouse 341.93 4 Abbey Court Carlisle, PA 17015 Tammy Lee Karstetter Child 112 of decedent's 62,688.93 2001 Southside Drive share of real Newville, PA 17241 estate Melanie Ann Wertz Child 1/2 share of 62,688.93 2467 Little Buffalo Road decedent's Newport,PA 17074 interest in real estate Total 125,719.79 Enter dollar amounts for distributions shown above on lines 15 th,ough 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: A-SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) LAST WILL AND TESTAMENT 6 OF CLARENCE A.BRICKER I,CLARENCE A.BRICKER,of South Middleton Township,Cumberland County, Pennsylvania,being of sound and disposing mind,memory and understanding,do hereby make, ILI publish and declare this as and for my Last Will and Testament,hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death.by my Executrix or Executrixes,whichever the case may be,hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. 2. All the rest,residue and remainder of my estate,real,personal and mixed,and wheresoever the same may be situate,I give,devise and bequeath to my wife,JANET K. BRICKER,provided she shall survive me by a period of sixty(60)days. 3. In the event my said wife,JANET K.BRICKER, should predecease me or fail to survive me by the aforesaid period of sixty(60)days,then in such event I give,devise and bequeath all the rest,residue and remainder of my estate,real,personal and mixed,and wheresoever the same may be situate, in equal shares,to my daughters,MELANIE ANN WERTZ and TAMMY LEE KARSTETTER. In the event any daughter above named shall predecease me,I direct that the share of my estate that such deceased daughter would have received hereunder shall be given to her issue surviving me per stirpes. 4. I hereby nominate,constitute and appoint my wife,JANET K.BRICKER,as Executrix under this my Last Will and Testament. In the event she should predecease me,fail LAW OFFICES to qualify or fail to serve in such capacity,I nominate,constitute and appoint my daughters, SNELBAKER& BRENNEMAN. P.C. MEL,ANIE ANN WERTZ and TAMMY LEE KARSTETTER,as Co-Executrixes(or the survivor of them as sole Executrix)under this my Last Will and Testament.. I further direct that no person serving as Executrix or Co-Executrix hereunder shall be required to post bond to secure the faithful performance of her or their duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF,I have hereunto set my hand and seal to this my Last Will and Testament written on two(2)pages this 25th day of February,2010. (SEAL) Clarence A.Bricker Signed,sealed,published and declared by CLARENC;E A.BRICKER,the Testator above named,as and for his Last Will and Testament,in our presence,who,in his presence,at his request,and in the presence of each other,have hereunto subscribed our names as attesting witnesses. t (SEAL) (SEAL) -2- LAW OFFICES SNELSAKER& BRENNEMAN.P.C. COMM( NWEALTH " SYl V 1 SS. COUNTY OF CUMBERLAND ) We,CLARENCE A.BRICKER,KEITH O.BRENNEMAN,ESQUIRE and SUSAN L. MATRAZI,the Testator and the witnesses,respectively,whose names are signed to the attached or foregoing instrument,being first duly sworn,do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly,and that he executed it as his free and voluntary act for the purposes therein expressed,and that each of the witnesses,in the presence and hearing of the Testator,signed the Will as witness and that to the best of his or her knowledge the Testator was at that time eighteen years of age or older,of sound mind and under no constraint or undue influence. Testator a 33 �. q' i L�,{'z}, tz a , Witness Subscribed,sworn to and acknowledged before me by CLARENCE A. BRICKER,Testator, and subscribed and sworn to before me by KEITH O. BRENNEMAN,ESQUIRE and SUSAN L. MATRAZI,witnesses,this 25h day of February,2010. Notary Public LAW OFFICES SNELBAKER& COMMONWEALTH BRENNEMAN, P.C.. OF PENNSYLVANIA Notarial Saw Sandra K Shm'--,Notary Pu ft Medtaniosbtag Bozo,Cumberland County MY Cawnss E)Ores Nov.22,2011 Member,Pennsylvania Aaaodatlon of Nob lea