HomeMy WebLinkAbout05-20-13 J 1505611185
REV-1500 EX(02-11)(FI)
OFFICULL USE ONLY
PA�epertmmtdRevenue CountyCode Ymr FIIeNum6er
su.eeu or�ndroiaua�Tams �NHERITANCE TAX RETURN
ro eox zeoeo, 21 12 1018
HeMaburp,PA 17128-0807 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMOOrvrv Date of Birth MMDDYVYY
09112�12
DecedenTs Last Name Suffuc DecedenPs First Name M I
BRICKNER BARRY R
(If Applleable) Erner Surviving Spouse's Irdortnatbn Below
Spouse's Last Name Suffuc Spouse's First Name MI
BRICKNER JONI
Spouse's Social Security Number
THIS RETURN MU8T BE FILED IN DUPLICATE WRH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXEB BELOW
� 1. Original Retum � 2. Supplemental Retum � 3. Remainder Retum(Date of Death
Prwrto 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Inferest Compranise(date of ❑ 5. Federal Estate Tax Retum Required
death aRer 12-12�2)
� 6. Decedent Died Testate � 7. Decedent Mainteined a Living Trust � 8. Total Number of Safe Deposit Bo�aes
(ANachCopyofWilq (AriachCopyMTrust.)
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11. Eledion to Tez under Sec,g113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- TNIS SECTION MUST BE COMPLETED.ALL CORRESPONOENCE AND CONFIOENTIAL TAX INFORMATION SNWLD BE DIRECTED TO:
Name Daytime Telephone Number
DONNA M• MULLIN CPA 717-761-7210
� REGIS'IEimFMIILLSUBE�,Y � �
+ O
C? � -�? 4—�j �
First Line of Address ;j •�'- �' �` `� Q
r r "
r�.� -t
BOYER & RITTER CPAS '�': cn` =�� � :..
- ,:
SewndLineofAddress �� °-i �`
211 HOU3E AVENUE � 7
City or Post OfFce Slate ZIP Cade
oourE Fl�n c 'c ��
... l�� �..)
CAMP HILL PA 17�11 `�' 't
c,rre.p,,,u.ntYa�W�adaras: DMULLINaCPABR.COM
Untler paneldee of peFury, I deelaro that I haw mmmined thk ieWm,IntluEing accampenylnp aclietlulen en0 atafemeMS,enE to the hest af my knoMeUpe and beliet,
it ie true,cortect antl complete. �ecleratlon ot DreDO�aher than the penanel�epresanfatlw ie besad on dl intarmatlon at wh�h preparer hn any knoMetlpa.
SIGN4TUREOF PERSON BLE FOR FWNG RERJRN
JONI BRICKNER, ADMINISTRATRIX rjt� �`����
nooRESs
29 HICKORYTOWN ROAD CARLISLE, PA 17241
sc�unx�oF ar�az�oTM�nuw�ar�nrrnrn� on�
DONNA M• MULLIN, CPA �.��'��� �/� ,���/3
noo�ss
BOYER & RITTER, CPAS, 211 HOUSE AVE CAMP HILL, PA 17011
IN Y
Slde 1
� 1505611185 OMA64]3000 1505611185 �
�
� 1505611285
REV-1500 EX(FI)
o�a�r.r�e: BRICKNER BARRY R
RECAPITULATION �
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 0 . �Q
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . Z. 0 • �0
3. Closely Held Corporation,Partnership a Sol�Proprietorship(Schedule C), , , , , g. � • 0�
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q. ❑ • 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Praperty(Schedule E) , , , , , 5, 7Ia�4 9 8 - 0 0
6. Jointly Owned Property(Schedule F) � Separate 8illing Requested , , , , g. � , 0 Q
7. Inler-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Bi�ling Requested . . . . 7. 6 4,6 91 . 00
8. To41 Gross Asaeb(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 L 41,18 9 • 0 0
9. Funeral E�enses and Administratioe Costs(Schedule H). . . . . . . . . . . . . g, 14,4 0 5• 00
� 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule p , , , , , , , , , �0. 9 7$• ��
11. Total Deduetbns(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , ��. L$,3 8 0 .0�
12. Net Value oT Estate(Line 8 minus Line 17) , , , , , , , , , , , , , , , , , , , �p, 12 S,8 0 9 - 0 0
13. ChaMable and Governmental Bequests/Sec 9113 Trusts fa which
an election to tax has not been made(Schedu�e J), , , , , , , , , , , , , , , , �3. � . p 0
14. NetValue3ubJecttoTaz(Linel2minusLinel3) , , , , , , , , , ,,, , , , , �4. 125�809 •00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 ta�able
at the spousal tax rate,or
trensfere under Sec.9116 �
(a)(1.2)X.OU 125,809 •OU �s. O .DO
16. Amount of Line 14 �le
atlinealratex.o4� p .pp �s. 0.00
17. Amount of Line 14 ta�le
at siaing rate X.12 0-0 0 1�, � •0 0
18. Amount of Line�14 tamWe
atcollaterelrateX.t5 � .�� 18. 0 • �0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. O�O D
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYNENT ❑
Side 2
� 1505611285 1505611285 �
omaeae 3.oaa �
_
REV450B EXi(11-10)
pennsylvania SCHEDULE E
OEPPHIMFMOF RE�ENUE CASH, BANK DEPOSITS,&MISC.
'���M�'" �xsowa�PROP�nr
ESTATE OF: FILE NUMBER:
Barrv R. Brickner 21121018
Inclutle the proceetls W INigetion an0 the tl�e the pioceetls wara recNVetl hy tM eatffie.
All ro ointl owned wkh ri ht oF survNorshi mwt bs dbelowd on Sehetluk F.
REM VALUE AT DATE
NUMBER p�R�p�pN OF DEATH
i. 1986 Dump Truck valued at sale price 15,000
2 Eager Beaver Trailer valued at sale price 3,000
3 Case 1845C Uniloader valued at sale price 10,000
4 Caterpillar 953 High Lift valued at sale price 15,000
5 John Deere 310D 1996 Backhoe valued as sale price 17,000
6 2004 Dodge 4X4 Pick-up truck valued at sale price 14,500
7 Earned income tax refund for 2012 600
8 Health Insurance Premium refund paid to spouee 967
9 Erie Inaurance refund 31
10 1/2 interest in Welder Co-owned with son; valued at 50$
of appraised value, appraisal attached. Spouae aucceeda � .
to 1/2 interest as sole beneficiary o£ estate. 500
TOTAL(Also enter on line 5,Recapitulation) $ 76,498
oWa6AD 2.o0o If more spece is neetleQ use atltldional sheets of paper of tha seme siza.
REV-i5f0 EX+jqB-0g)
pennsyivania SCNEDULE G
f1EPAF2TMENfOFREVENUE IN7ER-VIVOSTRANSFERSAND
It�ERfiANCEFAXRENRN �i1ISC,NOPi-PROBATE PROPERTY
l�SIDEMDECEOEM
ESTATE OF FILE NUMBER
Sarrv R. Hriaknar 21 12 1018
This schedu#e must be cwnpieted and fited if the answer to any af questians t ihra�4 af page ttx��the REV-15W is}es,
ONQFPROPERTY
ITEM mr�.�nenerw.EOrrve�rtwacv��ars¢nnareneroo�wrpw DATE4FDEATH %OFC7ECD'S IXCLUSI4N TAXqBLE
NUMBE 1}EOPIEOFIPMtlPBSATI/CHAOXMOFIlEO�fqItPEKEBlRTE. VPA.UEOFASSET papu VAlUE
�� Edward Sonas ZRA Aceount �377—
94385 per valuation letter
attached; spouee ia sol�s
b4ne£iciaxy. 58,45? 104.0000 0 58,657
2 MST IRA Account #350042q0215372
per 9128112 statement attached,
spouse is sole bene£iciary. 6,634 100.0000 0 6,63d
-- T4TAL(niso enter on�ine 7,Recapiwlalion)S 64.fi41
If mare space is rtetded,use adtlltionai sneeis bt paper of tn9 same size.
9W46AF 2.000
REV-t5tt E%*(90-04}
pennsylvania SCHEDUtE H
CEPMI0.IEMOF REVENl1E FUNERAI.EXPENSES ANQ
inrioar,wcera:cR�uRN AdMINISTRATIVE COSTS
r�s�rrr�Hr
ES?ATE OF' FILE 4it�R
_$ r�ry� R. Brickal�r 21 12 1018
DecedenPS debts must be rpportetl on Scfiatlule t.
ITEM
NUMBER OESCRIPT1pN AMOUNT
A. FUP�RALE?SPENSEB:
� Hoffmaxi—ROth Funeral Hoae 20,9II2
2 Ebg Granite (memorial markar) 2,568
B. t�NISIRATNECOSTS:
1. Personal RepresenlatF�e Commissions:
Name(s)of Pers�nal RepreseMatfoe(s)
Street Address
City State ZIP
Year(s}Comm�sion P�cf: �
2. Attortrey F6es:
3. Family Ewemptiore pf decedenPx address la not the same as claimanYs,aGach e�qNanaUon.)
C�atmant
Street Atltlress �
City � State ZIP
RelatipnshipafGiaimantMDacedenf �
4. Prob�eFees: 295
5. AccountantFees:
6. T�R�um Pr�arer Fees:
�oa
�.
None
� _ TOTAI(Aiso enter on I.Ine B,Recepitulationj �S 14,405
AW48AG 2.W� If more space is neetled,use atltlitional sheets of paper of lhe same size.
REY-15i2EX+{i2-�) �HEDULE 1
pennsylvania
oEamm��m oF r�+�ra� T�TS OF DEGEDENT,
INI¢FtITANCEiPXRETl1HN pApRTGAGE LIABILITIES 8 LIENS
£E310ENf OGCEDEM
ESTATE OF FlLE NUMBER
Bairy R. BTickner 21 22 101$
Report Gabls ineurced by fhe Aecedent prtot to death that remairmd unpaW at tlre date af deaih,IncludMg unreimbwsad metlital aupem�ee.
ITEM VALUE AT DA7E
NUMBER DESCRIPTION �'LIEATF{
�- xersh�y NSidieal Center 100
2 Chase Credit Card 875
i9TAL Also enter on line 90,Reca itulation S 975
ewasnn 2.000 � i If more space is neetled, insert atldttionel sheats of the same size.
REV•1543 EX+{01-t0) SCHEDUL.E J
pennsyivania
pEPPftThEMOF RE�ENUE BENEFICIARIES
IhqiERRpNCE7AX RETUFtN
F2�91DEMFDECEDEM
E3TATE OF: FILE NUMBER:
R. Bri ner 1 12 0 8
RELAT16NStiiPTO DE9EDENi AMOUNT OR 5HARE
NUMBER PiAME ANQADDRESS OF PERSON(Sj RECEIViNG PRCJPERTY Do Not Liat Trusha(s} OF ESTATE
I TaXABLE DISiRIBU710N5 pnclutle outrigM spouael tllsMbutbna sntl haishrs untler
Sec.9116(a)(12J.]
�. Joni Srickner
29 Hickorytown Road
Carlisle, PA 17261
Sole beneficiaxy af estate after
decedrant's children diaclaimed in
favor of deaedent's mpouse. Named
benePiaiazy of IRA accounta. &urvivinq Spouar� 125,809
2 Jared Hrickn�mr
. 114 Harners Road
Carlisle, PA 17015
Disclaimed intesta�a share in favor
of decedent's spouse; copy a£
disclaimer attached. Son 0
EMER OOLI.AR AMWNTS POR DI5iFtIBU110NS SHpWN A90VE ON LINES 15TiROUGH 18 OF REV-1500 CpVER SHEET,AS APPROPRIA7E.
�) NOC+TAXABLE DIS'fRi8U710N5
A.SPOUSAL PiSfRletJl'IONS UNDER SEC170N 9179 F4R WHICH AN ELECiION TO TAX IS NOTTAKEN:
L
8.CHARITAOLEANO GOVERNMEMAI OISTRIBU710NS:
t.
TQTA�OF PA#2T II-ENTER TOTA�NON-TAXABLE 6ISTRIBUTIONS ON LthlE 13 OF ftEV-15Q0 C4VER SHEET. S 0
awasni z.000 If more space is neetled,use additional sheets of paper bf the same size.
Estate of: Ba.rry R. Hriekner 21 12 1018
Sqhedule J Part 1 (Page 2)
Ttem
No. Description Relation Amount
3 Meredith Brickner
20 S. Chestnut Street
Elizabpthtovm, PA 1?022
Diselaimed intestate share in favor
of dec�deat'a apouae; copy of
disclaimer attached. Daughter q
4 Hannah Srickner
256 3. Evalina Street
Pittaburgh, PA 1522A
Disclaimad intestate share in £anor
of decedent'e spouse copy of
disclaimer attached. Daughter 0
_
DRESSEL
_
WELDING SUPPLY
12�� � gStLane,C,' �"e;, ', ;� ��; , *
� � .S£���i�l , �Y f 'Y'�"y'i' yj-� .Ge�.� k�i~'6 p. '�5 t � A�A ` } t
'.��""` 'ne,aTra � a�j,:��'��� ����'��
� � ni4e��� �� ,����"���"��r
�a; a� �
i�s�,�rnm �nS. .��,��., ff� �P� �' ��,_ �� � -h .
s p�" i r
t .�.^mdP . ..- . � ++n'
'
;�,. � �`tv_.,'._s : . . !�v,�tCCOf�� yr�� x������' �� ,�-' . d*F .g`. . .
TO: Jazed Brickner
PROPOSED SHIPPIIVG DATE: A,s Agreed TERMS: Net 30 days
SHIPEED VIA: Best Way SALES PERSON: Troy Getz
F.O.B:: Destination DATE: 10/03/12
COND7770NS The prices and[erms on[his quota[ion are not subjec[[o verbal change or o[her agreemen[s unless approved in wri[ing by[he Home Office of tlie
Seller. All quotationsand agreements are contingen[upon shikes,acciden[s,fires,availability of mamrial and all other causes beyond our conVol. Prices are based on
costs xnd conditions ezisting on daze of quo[a[ion and are subject to change by Seller before final ecceptance.
Typogrephical and,s[enographic errors subject fb correction. Purcheser agrees to eccept either overage or shortege no[in ezcess of [en percent ro be charged for pro-
-iSfa. Purchaser assumes liability for patent and copyright infringement when goods ete made to Purchaser's specifications. When quo[ation specifies material to be
fiimished by the purchaser,emple allowance must be made for reasonable spoilage and material must be of suitable quality ro fecilitate efficient production.
Condi[ions no[specifically sta[ed heroin shall be govemed by es[ablished vade customs. Terms inconsistent with tliose stared herein which may appear on Purchaser's
. furmal order will not be bindin on the seller.
"_x�: i a3 L a y u� Y�'�rt' b . 1 ':4?s � .'.r.
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, x�.._ _ .
QTY DESCRIPTION PRICE AMOUNT
lea Lincoln Electric Power mig 255 Used w/ Spool Gun $1000.00
Note:
ARer reviewing the replacement cost of the comparable machine and age and condition of this machine; in my
professional opinion this would be a fair mazket price for this particulaz welding machine.
THIS QUOTE VALID FOR 30 DAYS BY
Page: 1 Document Name: untitled
PSBLREAQ Cnstomez Service Workstation 14: 11:32
EBRN6MW IRA Account Balance 12/09/28
Account #: 350642d0215372 Product: REA SubCOde: RK
M&T BANK
Title l: BARRY R BRICISNER SSNITIN: 191429Q32
2= Package;
Region : CEPA
Status : INACT - 3M BUSN
Maturity: 13/07/05 Restraint: N
Current Balance : $ 6, 63p.69 Last Deposit Amount: $ 1.97
Accrued Znterest ; $ 3 .13 Last Deposit Date . 12I46J05
3nt Pd Prior Cycle : $ 1.47 IRA P1an Type Code : RI
Date Transactipn DfC Amount
46lO5 *RENEWED AT 0.15$, MATURES C $ 6, 630.69
06/OS INTEREST PAYMENT GENERA'PED C S 1.97
O5/04 INTEREST PAYMENT GENERATED C $ 23 .22
OS/OS *RENEWED AT 0.35$, MATtTFZES C $ b, bd5.5d
05105 INTERESfi PAYMEIV`I' GENERATED C $ 4.08
d4IQ5 INTEREST PAXMFNfi �ENERATED C $ 49.32
44t05 TERM CHG = 0.75$, MATURES N $ .OQ
F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous
Date: 912$J2412 Time: 2:13 :26 PM
Fage: 1 Document Name: untitled
RR06 VER: 11. 0 R R S --- CUSTOMER INFORMATION OPERATOR
09I28112 14 :10:57
SNST 040096 RETIRE ID 0191429432 SSN 0191429032 PROFILE ID
NAME 1 BARRY R BRICKNER NANtE 2
TITLE TAX ID TYPE S TELE. ALT. PAYEE N 1099R QUAL FC N
ADDI2 1 29 HICKORYTC7WN RD ADT?R 2
CITY CARLISLE ZIP CD 17013-9724 BAR CD P05TAL PA MAIL R
PLAN TYPE RI OWRTER SPptVSOR N QUALIFIER R ED SPEC IVEEI} N
FUND Ct}I}E 41 PLAN CODE DEPqS BAN N DEC/ABN N
PLAN DATE 000000 EN'I'RY DATE p00000 CLOSE DATE 000000 ATB SW
BIRTFI DA1'E 030755 1 EARLY I}ZSB 49Q714 2 REQ D3SB 090725 2 IPi$UR
LAST ACT DT 081503 LAST MONEY AT 000000 LST CNTCT OOOOOQ 0
SERVICE CHG CI} N ACCOUNT AM`P d.pQ AMT CI}
DATE BILLED 000000 DUE 000000 PD p00p00 USER 4344035004200215372
BENEFICIARY CONTACT BRANCII 6b66 STMT CYCLE
L1 ,7flNI K BRICKNER L2 AS OF 071598
L3 L4 OODOD
DEC i2ID DEC SSN DEATH DATE d000QQ DOD VALITE 4.OQ
NONDED CONrRIB TOT/DT 0.00 000000
Z-ACCT 3-MpN.TRAN 4-SMI�fftY 5-DISB. 6-ACCT LSST $-ALfi.PAYEE 9-DIBCREP.LIST
A-ATB C-TIN F-SER FEE N-IVRA: _ DELETE PART � PRESS PF3 FOR PART MENU
]7ate: 9/28/2012 Time: 2 :12:52 PM
Edw�rd,�ones
CQST4IR.�R 2SP298: BRSCffi1RR. SRRRY IRA DS82`SHATION:. bIB'RP P.CC4t7NT8
ACCOIFN"F' NCII�BR: 377-9a385 BRANCfi #: 03772 DATB: Oa/��gU
EDWARb JQNE9 Il�IDIVIDUAL RETIItPNffi�"P ACCOUNT
A�THORTZATIdN, ADOPIYI�I A6RG�MtGNT md BEl�I7CIA�Y DSSIGNAISUN
fat�+rcx2s a�? 4'� ��� ❑ n,�mn f� �-mn ❑ sum�.e,xn
Mmoo[HOkcNmne BARBY R BRIClC[iER
�aare. �9 ��ctm�ee�{�amrr an cur es�x�xszs sum pa zm z�a?s-o�sa
Dupof� 03 I 07 l 19�5 9qdat9erauhyN'rvn6eR 191 - 42 - 9032
Ssaaiiaiarp aesa�at�a
8R"L1�18Y H�1rICTASISB:
S41PI SC BRICRNBR BPOUSB?SYfN} : Y 1Q0.00$
29 FIICKO1tYTO4JN RL7
CARLISLS PA 17018 9T24
DATS QF $IRTIifTRtC3T: OljlBj1958 ssxl`r�uc sa #: s-issaaezsa
COI�ITT116II/T 83!ffiIC7,A8S8f8 s .
� a� siuc� spovs�?{YJ�s} : � $�,r,
DAY'E OF BIRTH/TF2[TBT: 09/19/1989 8SN/TAX ID #: 8-198705423
SAR&D S BRICRIS[t. SPtl'US$?{YfPT} « Dl BQUAL
DATS OF BIRTET/TRUST: 03/11/1984 9SN/TAX ID #: 8-166663931
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DOC-bKi:108315-23682 $BC9UR CODB: 041,
Paac 1 nf 2 (Rev.193ep 20118j
_
,�,,,�,n�, 29 We�High 3ueet Edward�ones
Financial Advisor Carlisle, PA t7013
$US 71.7_25$_4688 MAKING SHNSE OF INVESTINO
Mrs.Joni L.Brickner September 28,2012
29 Midcorytown Rd.
Cariisle, PA 1?016-9724
Dear Joni:
Re:Aa�unt 377-94385-1-8
This latter is being sent,per your request,to provide infarmation for the following securities held in Traditional IFtA account
owned by Barry R.Brickner.These values are shown as of the date af death, September 11, 2012.
(2uent4ty Des�cripdon CU51P or Valire Total Value
Symboi per Item
248.696 Europac'rfic Grwth Fd CL A AEPGX $39.39 $8,717.35
#p2.$1 M&tta�rs E3ond Fund MGFIX $27.4$ $2.82522
320.741 New PerspectEve funti CL A ANWPX $30,22 $9,674.66
77.653 New Wadd Fund CLA NEWFX $51.58 $4,004.18
87.563 Small Cap Worid Fund CL A SMCWX $38.81 $3,398.32
905.788 Washington Mutual Inv Fund CL A AWSHX $3t.40 $28,441.74
Sincere ,
t,t�'L�il2�� ��-�'
Ramona Mateya
Branch Office Adminis�tratpr
Edward Jates, its em}�loyees atrd ffrranciat adv�rs da hot provlde tax or lege!advice.You should consult with a qualffled
tax specialist or legal advisor for professfona/advice on your spec�c situafion.The Inlormation pravided is believed to ba
relfabte,buf!fs aIX;uracy and compteteness are Rof guarart2eed.
Cosf basis informatiort may be from an autsfde saurce that has net kean verif"red.Cost
basis is provided for information only and should not be used for ta�c purposes without
the assistance af yaur tau Areparer.
www.edwardjones.com
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vaiv r�nnou. cracN-cvic (, ,,,,/,�,�r������
Financial Advisor: Art Amundsen �'�l.l c�i
Pha�e: 717-258-4888
P&ge 1 af 1
Historical Pricing for Brickner, Barry R !RA
Symboi pescrlptioryT�ype Date Value
AEPGX EURd PAC�ROWTH FD SH BEN INT
Net asset vatue(adjusted} 11-Sep-2Q12 39.390Q USD
MGFIX MANAGERS FUNDS SD FD
Nat asset value(adjusted} t i-Sep-2012 2�.4800 USQ
ANWPX NEW PERSPECTIVE FD INC CQM
Net asset value{adjusted) 11-Sep-2012 30.2200 USd
NEWFX NEW WORi�FD ING NEW COM
Aiet asset value(adjustsd} 11-Sep-2012 51.SBOl7 U$D
SMCWX SMALLCAP WdRLD FR INC COM
Net asset vaWe(adlusted} 11-5ep--2012 38.$1�USD
AWSHX WASHINGTON MUT INVS FD iNC COM
Net asset value(adjusted) 1 t-Sep-2d12 37.4000 USD
Thie rs�rt is provided by Edwarcl Janes.'fhe raport was calculated uafng tlitrd party informatlon.Thia report I�not iMended to replace oHiclai
documenta such as coMirmations anNOr ac�count atatemer�ta ihat shouid be refafied for ta�c purposas.Paat piMom�anee is�ro gueraMee ot futwe
reouits. EdwaM 3ones does not provide tax or iegai advice.l�s shouid cnnsnft yrour tax andfor tegai advi�tor your perticular situatlon.The historical
coat�iotarmatla�fum�hed h�n("ink�rmatias')is for use by cus�mer{"you`)only and Ia based on the purchase and aale InformaBon provided.
WhiW Edward Janes beAeves fhat the informatlon was obtained from reliable sources,Edward Jones does not guareMee the awuracy or compietenass
of fhe Informatian and is fumishing the InfortnaBon to Vbu on an°a�—is°basis.EDWAR6 JONES MAKES NO WARWW'fY t7F ANY KIND,IXPRESS
QR 1Mi�LIED,WiTN RESPEGT TO THE MERCtiAPtTABiL17Y,FkTNESS,CONQITION,USE OR APPROPRlATF�IESS OF THE INFORMATION,Edward
Jones i�suppiyUtg ll�e tnformation on the basis that the Informatlon will be used by You for Your own use end benefit and not for resaie or other transfer
to,ar use by or far the bensfit of,any other peraon ar enUty.
QUAI,IFIED DISCLdIMER
In nccordance with Iniernal Revenue Code Section 2518(b)and pursuant w Sectioa 6201
of the Femnsylvania Prabate Estate snd Fiduciaries Code, {24 PA.C.SA. Secfion 6201), this
Qualified Disclaimer ie bes'ng e7cecutefl by the tuidttsigned 1�encficiazy, HA.NNAII
BRICKNI:R, in order to disetaim in whole ati of her interest in the �3TATE OF BARRY R.
BRICKN�:R:
The; uadersigned, as one of the beneficiaries in the above-referenced fistate is hereby
discleimin��her interest in the estate in favor of her mother, JONI BRICKNER,as evidenced by
the undersigned's eacecution hereof.
This discla3mer is axecnted as of this�day of March, ZU13, the sazne being
cffective a�of the date of d�th of the decedent,Herry R. $rickner on September 11,2012.
WiT'NESS: r ``.
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HANNAH HRICKNEIt; � � � �
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COUNTY OF C.v,th7pet'�4+�f�+ ` s`-a , ^' �" -°�,
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On�is,the,.�J day af Merch„ 2013, before me, the undarsignad officer, personst(y
appaared fTannah Brick�> knorom to me (ar satisfactorily proven} to be tha persun wh�c name is
subscrikred to the within instrument, and acknowledged that she exeeutetl the seme for the purposes
therein conrtained.
In witness w6ereof,I riereunto set my hand and officiat sexl.
��,��� ..__ (SEAL}
CirYMaBorab+�tt���d�r�r Nflta�}, ___.
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Q(TALIFI'ED DISCL.�IMER
In a�cordance witts tuternst Revenue Code :�ec#ion 2518{b)and pursuenC to Sectioa 6201
of the Pennsylvania Prabate Bstate and Fiduciaries Code, (24 PA,C.S.A. Section 62pi), this
Qualified Uiselaimer is heing cacecuted by the undersigned beneficiary,JA1tED BItICCZNER, in
order ta dis�iaim in whole ati af hes int�est in Lhe E3TATE OF BARRY R.BRICKN'ER:
The: undersiEn�i, as one of the beneficiariea in the above-refereuced Estate is hereby
disclaimin�her interes�in the estate in favar of his mather,JUNi BRYCKNEIt, as evidenced by
the undersigned's e�cution hereof.
'T'his disclaimer is eacecuted as of this - J day af March, 2013, the same being
, effective a;ef the date of death of the decedent,Berry R. Brickner an September 1 i,2Qt2.
WIT1�TEt.S.�i:
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O�r this,the_���day nf March, 2Q13, l�efore t�, the undersigned nfficer, personally
eppeared J,nred Briclmer, known to me (or setisfactorily pmven) to be the person whose name is
subscribed to the within insnument, and acknowtedged that he executed the same for the pucposes
iherein con�ained.
IA tN1klBS3 WIICCCOF,I hereunta set ray hand and o e" eal.
(SEAL)
Notary Publie
C6pNt���7�
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QUALIFIED DISCLAIMER
In accordaac�with Intemat Rev�ue Cade Sectian 2518 (b}and pursuant tcs Secdan 6201
of die Penrisylvania Probate Estate and Fiduciaries Code, (24 PA.C.S.A. Sccction 62017, this
Qualified l�isclaimer is being executed by the undasigned bensficiery, MERED1T�i
BRICKNER, in order to disclaim in whole sll of her interest in the IESTATE OF BARItY R
BRICICl�F�R
The unci�sign�, as one af the beneffcieries in the abave-referenced Estate is hereby
disctaiming her interest in the estaCe in favor of her mothet,JOHI BR'�CICNER,as evidersced by
the undersigaed's exe�cutian her�f.
Tlll£s(�ISC181IIS0T IS BXGCllYBd SS BPt�tIS„�,�,day af March, 2013, the sarne being
effectivc a;of thc date of death of the decedent,Barry R Briokner on September 11,2012.
WIINESS:
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COUNTY�OF Cv.vvi�C.+C1Ge� . r-� , cn -n
On this,the�day of Iv(srch, ZQ13, 6efore me, the undar�igned offscer, personsity
appoered Masdith Brictmer, known to me {or seLisfectarity prov�t} ta 6e the person whose name is
subscribtd #o the within iasGcumant, and acimowledged that she exceuted the same for the purposes
therein aonvsined.
In witness wherao�I hereunto set my hand snd officiffiI seal.
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��,g� (SEAL}
AIOROAH�.rbhary Pu66c Natazy Pub--
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