HomeMy WebLinkAbout09-11-13 �
J 15U561U143
REV-95t18 �"�-"' '�
PA Depadrnent of Ravenue ��ya��m OPFICIAI.USE ONLY
Bureau of Indivitlual TaIXes ��M�"�^°F��^'� �'"�'�Od° veK Fa.N�mcar
PQ BOX_2806�1 INHERITANGE TAX RETURN 21 12 1155
Hartiaburg,PA 17'i28�,0601 RE$iDENT DECEDENT
ENTER OECEDENT INP4RMATION BEIOW
Socia�Security Number Date of Death Date of Birth
oa ss Zaia os zs zssi
DecedenYs tast Name Suffa Decedent's Fira#Name MI
BRICKER CT.nstFN� A
(If ApplicaWe}E�ter Suniving Spowe's infamadon BsWw
Spouse's Last Name Suffix Spouse's First Name MI
SF��sa's Scuai£scuMy Mumbe:
TFIIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILlS
FIL!IN APPROPRlATE QYAE.S BEIOW
� 1. Original ReWm � 2. Supplementel Rekum � g. Pn�mal�nder�eB2�(Date b(Desth
� 4. Umited EbYate � 4a.FW1Y°�mereet cam�ramiie � 5. Federel Eslete Tau Retum Required
(ae(eMtleetll8fter 2-12A2)
� 6. (�Co�p�y�o1 WIIIet)1e � �� ����il�'Ne��Livilig Truet � �, Tof81 Numb9r Of S9fe D8�7osit Bo%es
� 9. Lldga6on Proc�eds Received [� +a.�01�,?g�,�g�j�{oad�«o�n„ � ��.Eleckion to ksz under Sec.8113(AJ
tn�a,sa,ea�o>
CORRESPONDEN7-THIS SECTION MUST BE CpMPLETED.AlL CORRESPONDENCE AND CONFIDENTIAL TA7C INFORMATI�ti$NQUtD BE DIRECTED TO:
Name 8aytime Teiephor[aNumber�
MARK A MATEYA �� a4z ��oQ.;; ��,
�: �, �:o :::��
R�I�E�F WI�I LS U&E O�1LY
t-- _. e.- r-+ . ._s
T" G') r.:�=
First Line of Address :.�_ . . � -+
' 55 W CHtTRCH AVENiTE e, � � �
�;� c � c ,+
Secand Lirre of Address . =�c'� t=? '° ;�;�
-v �� � c�
*.s $ ,� i
DA7E F!LE� �
City or Post Offlcs g}a�,q yp C��
CARLI3LE PA 17013
correaponasnes e-ma�i address: mam(�ma�yaiaw.com
unaer Pensmes m r,e�un,�dec�are v,at�nsve e�m;r�d mre re�um,Mca,a���aem�ecneduba en�ssratemema.���ere�na a�yk°°'iirre°ow�g8eae�.
it is Vue,�aroi campbte.DectareNpn af propereroihm fhan fhe personai repreasnis6ve is beaed on a i inlormstion of which
S16NATU `�F PERSON RESPON t�E OR FII.ING jRETURN DATE
�h�ct�- 7.�hr,Q.l�yl� Janet K Bricker �.3 — /_'�
AOORESS
4 Abhe ,Court Carlisie PA 17418 /
SIGNATUftE PREP ER THE RESENTATNE y R E � J i3
Mark A.INate a
.� �
ADDRESS
55 W. Church Avenue,CaHisle, PA
Side 1
L, 1505610143 1505610143 �
��
J 1505610243
REV-1500 EX
DecedenPs Social Security Number
Dace°°^�°"°^re gricker, Clarence A
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(SChedule B)............................................................................. 2.
3. Closely Held Corporetion,Pertnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mor�qages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal PropeRy(Schedule E)............... 5.
6. Jointly Owned Property(Schedule F) ❑ Separete Billing Requested............ 6. 39�205. 65
7. Inter-Vivos Trensfers&Miscellaneous I�q-Probate Property
(SChedule G) U Separete Billing Requasted............ 7. 125,377 . B6
8. Total Gross Assets(total Linas 1 through 7)........................................................ B. 164,583. 51
9. Funeral E�enses and Administrative Costs(Schedule H).................................... 9. 8 , 663 . 95
10. Debts of Decedent,Mor�qage Liabilities and Liens(Schedule I)............................ 10.
11. Total Deductlons(total Lines 9 and 10)................................................................ 11. $, 663 . 95
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1$5� 919. 56
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
� an eledion to tax has not been made(Schadule J)............................................... 13.
14. Net Value SubJect to Tax(Line 12 minus Line 13)............................................... �q. ],55� 919. 5 6
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 tauable
at the spousal tax rate,or
transkis under Sec.9116
(a)(t.2�x.00 30,541 . 70 ie. 0 . 00
16. Amount of Line 14 taxable
at�inea�rate X .oa5 125�377 . 86 ts. 5� 642 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0�0 17. 0 . O�
18. Amount of Line 14 taxable
at collaterel rata X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. $� �i42 . ��
20. FILL IN THE OVA�IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 Fiie Numbsr 21-12-1'155
Decedent's Complete Address:
DECEDENT'S NAME
Bricker,Giarence A
STREETADDRESS i � �
Z31 Plne Raad
GITY —"--'--- — --�gTqTE ZIP
Mount Hally Springs PA 17065
Tax Payme�and Credifs:
1. Tau Due(Fage 2,Line 19} {1} 5,6d2.00
2. CreditslPayments
A. Pdor Payments 5,642.00
B. Discaunt
--�— rotal creaits{n +e} (z7 s,s+t2.00
3. Interest (3}
4. if Line 2 is greater thae Line 1 +Line 3,enter the difference. This is the OVERPAYMEN7. �4�
Check box on Page 2,tFne 20 ta requast a nfund ' –
5. If Line 1 +Line 3 is greater tha�Line 2,enter the difterencs. This is the TAX DUE. {5) {},{}O �
I Make Check Payable ta: R�GISTER OF WILLS,AGENT.
PL.EASE ANSWER THE FOI�OWiNG QUESTIONS BY PI.AClNG AN"X"IN THE APPROPRtATE BLOCKS
t. Did decedant make a transf9r antl: Yes Na
a. retafntheuseorincomeottheproPertYUansferred,.........._................_..................._......._........_......... x
b. retain the dght to desgnaie who shail use the property transferred pr fts income:..................................
c, retain a roversianary Interest,or....._..._._................._.........._......._.....----.._._..........___....._................ x
d. receive the promise Por I'rfe of either payments,benafits ar cera?......................................_...,,...............
2. It tlesth occurretl after Dec. 12, 1982, C� decedeni transfer property withi� one year of death r�ithout
receiving adequate cansideretion?..................................................................................._..........:.................... ❑ ��'I
3. Did decedent avm an"in truat for' or payable upan deaiti ba�k acxaunt or security a#his or her death?....... ❑ U
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
co�tainsabenefiiciatydesignationfi.._................._............................................_............................................. ❑ �
IF TWE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YqU NIUST COMPLETff SCHEDULE G AND FILE IT AS PART OF TME RETURN.
For d9tes ot dsath on pr after July 1,1994 and before Ja�.1,t995,the taic rat�imposed on the net value of transfers ta or for Me use of the surviving
spouue is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates W c�ath on ar after JanuaN�,'��5,She tac reie imposed on the net value of tra(re£ers to or for the use of Me s�rvivi�spovse is 0 parcent
[72 P.S.$9116(a)(1.1)(ii)]. The statute does not exempt a trensfer to a surviving spouse from tau,and the statutory requiremeots for disclasure of
essets and flfing a taac rrsturn are sti!!appiiqble evsn if the survivirw3 spause is the only benefiaary-
For dates of death on or aRar July 1,2000:
+ The ta�c rete imposed on the net vaiue of transfers from a deceesed chiid 21 years nf age ar younger at destb to or for the use of a natura�parent,an
adoptive parent,or a stepparent of the child is 0 percenk[72 P.S.§9116(a)(1.2)].
+ 7"ho tsx rate imposed a�the�et value of transfers to or tnr the nse of the decedenFS Iinea�beneficiaries is 4.5 percent,except es noted in
[72 P.S.§9118(a)(i)1.
. The t�rate imposed an the eet vaiue of hansfers to or for the ose ot the dscedenfa sibfings is 12 perCent[72 P.S.§911 B(a)(1.3)J. A
sibling is defined under Section 9102,as an individual who has at least mne parent in eommon with the decedent,whether by blood or adoption.
I
Rsv-t604 EX+{fYt.t4)
pennsylvania SCHEDUI.E F
o�ART��o�R�a�E JOINTLY-QWNED PROPERTI(
INNERITANCE TAX RENfiN
RESI�EM DECEDEM
ESTATE OP PILE NUMBER
Bricker, Ciarence A 21-12-1185
n.n wn wu mw•�ane,wmin ons rur m m•dw.d.nr•aa a a..m,It mwt be nportetl on Wchedul�6.
SURVIVING JOINT TENAN7{S)NAME A6DftESS RELA'flQNSHlP TO DECEDENT
A. Janet K Bricker 4 Abbey Caurf Spouse
Cariiste, PA 17016
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF pROPERTY o��F pitTE oF pEp7H
ITEM pOR�JOIN MADE uN�r.�s��a�RAR OENT�YNC.TN 1M ERAttn�Eo pR DATE OF DEATH DECD'S �cEO�er�ir�$,NieaesT
NUMBER TENANT JOiM JOINiIV-HElO REAL ESTATE. A�UE QF ASS ���EST
1 Members 7st Federal Credit Unian-Checking 4,369.79 50.004% 2,184.9Q
Account No.�xx-0011;JoiMly owned with
spouse
2 htembets 1st Pederat GrediE ltnion-Money 72,673.80 50.Od0°� 36,336.90
Management Account No.�aoacx-0005;Jointly
owned with spouse
9 Members 1st Federai Cred9t Unian-Savings 1.367.69 50.00p% 683.85 �
Account No. 34984-000
TOTAL{qlso entar on Line 6,RecapiWlation) 39,2Q5.B5
{If rtwre spaca is�atletl,atltlitbnai pages of ttre same size}
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