HomeMy WebLinkAbout06-13-14 REV-1 500 EX (e2-11)(FI) 1505610140
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO Box 280601 INHERITANCE TAX RETURN 2 1 1 3 1 1 5 8
Harrisburg,PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 0 2 6 2 0 1 3 0 7 2 0 1 9 3 0
Decedent's Last Name Suffix Decedent's First Name MI
B R I C K E R D 0 R I S L
(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 -
FXJ t.Original Return F1 2,Supplemental Return ❑ 3.Remainder Return(Date of Death
Prior to 12-13-82)
El 4.Limited Estate 4a.Future Interest Compromise(date of S. Federal Estate Tax Return Required
death after 12-12-82)
Q 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 8,Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
R 9.Litigation Proceeds Received 10. Spousal Poverty Credit(Date of Death 11.Election to Tax under Sec.9113(A)
Between 12-31.91 and 1.1.95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
M U R R E L W A L T E R S I I I , E S Q 7 1 7 6 9 7 4 6 5 0
REGISTER OF WILLS US£�,(dNLY
First Line of Address h �
zz
W A L T E R S & G A L L O W A Y P L L C ? n rc_� 1
rn M 1
Second Line of Address ` Cn -:ia r -0
cj
5 4 E M A I N S T R E E T cc
City or Post Office State ZIP Code �_ +j_ORE ILED .T. C i
M E C H A N I C S B U R G P A 1 7 0 5 5
ry -n
Correspondent's e-mail address: murrel(cliwaltersgalloway.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 knasiedge.
SIGNATURE 1�CRSON41RE�ONSLE F r/(LING RET_ URN / ~"6'•�DATE
=�
WILLIAM S . MO R/, 1A/4 S . MARKET ST MECHANICSBURG PA 17050
SIGNATURE OF E RE n T T REPRESENTATIVE L/f r ATZ E M�
ADDRESS
MURREL R • W LTERS , III, 54 E . MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DORIS L. BRICKER 21 13 1158
Decedent's Name Page 2 File Number
Correspondents
Name Daytime Telephone Number
M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0
First line of address
5 4 E . M A I N S T R E E T
Second line of address
City or Post Office State ZIP Code
M E C H A N I C S B U R G P A 1 7 0 5 5
Correspondent's e-mail address:murrel(Wwaltersgalloway.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the bestof my knowledge and belief,
it is true,correct and complete.Declarafion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
IGN TURE OF yERSO REW.QNSIBLE FOR FILING RETURN DATE
lf ESS
GUISE 1. ZELLER, 1370 FOX HOLLOW DR HARRISBURG PA 17113
J 1505610240
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name: DORIS L • BRICKER
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 and Notes Receivable(Schedule D) 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property 9 6 8 0 , 0 0
p rty(Schedule E). . . . . . . 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . .. . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . .. .. . . 7.
8. Total Gross Assets(total Lines 1 through 7) . .. . . . .. . . . . . . . . . .. . . . . . .. . S. 9 6 8 0 , 0 0
9. Funeral Expenses and Administrative Costs(Schedule H) .. .. . . . . . . . .. . ... .. 9. 9 8 0 1 . 1 4
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . .. .. . . . . . . 10. 5 1 8 3 . 6 4
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . .. . . . . . . . . . . . .. . . . .. 11. 1 4 9 8 4 . 7 8
12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . . . . .. .. . . . . . . .. . . . . . . 12. - 5 3 0 4 , 7 8
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. - 5 3 0 4 . 7 8
TAX CALCULATION-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 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.0_ 0 . 0 0 16. 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 , 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 , 0 0
19. TAX DUE . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240 J
REV-1500 EX(FI) Page 3 - File Number
Decedent's Complete Address: 21 13 1158
DECEDENT'S NAME
DORIS L. BRICKER
STREET ADDRESS
530 QUAIL COURT
CITY STATE ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3)
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
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 ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X
c. retain a reversionary interest ..................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?........................... ❑ ❑X
.......................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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
is 3 percent[72 P.S. §9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 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 V2 P.S.§9116(3)(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.
REV-7508 EX+(08-72)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN CASH, BANK DEPOSITS & MISC.
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
DORIS L. BRICKER 21 13 1158
Include the proceeds of litigation and the date the proceeds were received by the estate.
All propertyjointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MOBILE HOME 7,500.00
SALE PRICE
2. MEMBERS 1ST FEDERAL CREDIT UNION 1,280.00
CHECKING
3. HOUSEHOLD CONTENTS 900.00
TOTAL(Also enter on Line 5, Recapitulation) $ 9,680.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX-,08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DORIS L. BRICKER 21 13 1158
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. PARTHEMORE FUNERAL HOME, NEW CUMBERLAND 3,482.64
2. TOMBSTONE, GRAVE OPENING-ROLLING GREEN CEMETARY 3,970.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) WILLIAM S. MOSER
Street Address 1304S. MARKET STREET
City MECHANICSBURG state PA ZIP 17050
Year(s)Commission Paid: (RENOUNCED)
2, Attorney Fees: MURREL R. WALTERS, III 2,200.00
3. Family Exemption:(tf decedents address is not the same as claimant's,attach explena8on.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 148.50
6 Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 9,801.14
If more space is needed,use addivonal sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DORIS L. BRICKER 21 13 1158
Decedent's Name Page 1 File Number
Schedule H - Funeral Expenses &Administrative Costs - 61
ITEM
NUMBER DESCRIPTION AMOUNT
B. ADMINISTRATIVE COSTS:
Personal Representative Commissions:
2. Name(s)of Personal Representative(s) LOUISELZELLER
Street Address 1370 FOX HOLLOW DRIVE
City HARRISBURG State PA ZIP 17113
Year(s)Commission Paid: (RENOUNCED)
SUBTOTAL SCHEDULE H-B1
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DORIS L. BRICKER 21 13 1158
Report debts incurred by the decedent priorto death that remained unpaid atthe date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. RVG MANAGEMENT 350.00
LOT RENT
2. SPECTRUM UTILITIES 15.64
WATER
3. DR. RUPP 30.00
MEDICAL
4. PPL 143.00
ELECTRIC
5. MEMBERS 1 ST FEDERAL CREDIT UNION 4,645.00
PERSONALLOAN
TOTAL(Also enter on Line 10,Recapitulation) $ 5,183.64
If more space is needed, insert additional sheets of the same size.
REV-5513 EX+(DI-10i
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DORIS L. BRICKER 21 13 1158
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outfight spousal distributions and transfers under
Sec.9116(a)(12)]
1. RUTH E. STECK Lineal
1550 W.WILLIAMS GROVE ROAD, BOX 611
MECHANICSBURG, PA 17055
2. ANN M. CALLIHAN Lineal
235 LONG LANE
YORK HAVEN, PA 17370
3. NANCY L. MOSER Lineal
165 FRYTOWN ROAD
CARLISLE, PA 17015
4. WILLIAM S. MOSER Lineal
1304 S. MARKET STREET, UNIT I
MECHANICSBURG, PA 17055
S. LOUISE 1. ZELLER Lineal
1370 FOX HOLLOW ROAD
HARRISBURG, PA 17113
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
11. 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. $
If more space is needed,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, DORIS L. BRICKER, a resident of Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make, publish and
declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and
all Wills and Codicils previously made by me.
I
I declare that I am not married, my beloved husband, JOHN B. BRICKER,
having predeceased me, and that I have five children, RUTH E. STECK, ANN M.
CALLIHAN, NANCY L. MOSER, WILLIAM S. MOSER and LOUISE I. ZELLER.
II
I direct that all my just debts and funeral expenses shall be paid from my
residuary estate as soon as practicable after my decease.
III
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 from
my residuary estate as a part of the expense of the administration of my estate.
IV
I direct that my body be cremated and that the ashes be placed in a
suitable container and thereafter I direct my personal representative to have my
remains interred in Rolling Green Cemetery, Camp Hill, Lower Allen Township,
Pennsylvania. The remaining burial plot in our family lot at Rolling Green
cemetery I leave to my daughter, LOUISE L. ZELLER.
V
I give and bequeath items of personal property to specific individuals that I
have set forth in a list which I have prepared, signed and maintain with this Will.
VI
I give and bequeath my mobile home located at 530 Quail Court,
Mechanicsburg, Pennsylvania to my son, WILLIAM S. MOSER.
VII
All the rest, residue and remainder of my property, whether real or
personal, wherever situate, including any property over which I may have a
power of appointment, I give, devise and bequeath to my children, RUTH A.
STECK, ANN M. CALLIHAN, NANCY L. MOSER, WILLIAM S. MOSER and LOUISE
I. ZELLER, in equal shares, per capita.
VIII
I nominate, constitute and appoint my son, WILLIAM S. MOSER and my
daughter, LOUISE I. ZELLER, as Co-Executors of this LAST WILL, to serve
without bond. If either is unable or unwilling to act in that capacity, then the
other may serve alone as Executor.
IN WITNESS WHEREOF, I, DORIS L. BRICKER, have set my hand to this
LAST WILL this aI aet- day of —43;� , 2011.
DORIS L. BRICKER
Signed, sealed, published and declared by the above-named DORIS L.
BRICKER, as and for her Last Will and Testament, in the presence/pf us, who, at
her request and in her presence, and in the presence of e other, have
hereunto subscribed our names as witnesses
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
as.
COUNTY OF CUMBERLAND
I, DORIS L. BRICKER, 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 as my free and voluntary act for the purposes therein expressed.
DORIS L. BRICKER
Sworn or affirmed to and acknowledged before me by DORIS L. BRICKER,
Testatrix, this '�')151- day of �� , 2011.
Notary Public
NOTARIAL SEAL p[p[
` DIANE 41 SMITH S
Nctc:V Public FF
AFFIDAVIT ,A-.CPVWCSBURGeoa6,CUMBERL4NDCNI+
My Commisslon Expitos Jun 22, ?.012 1
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, Alwe12 2. C✓d a-r'�' ckr— and )�OSCM441
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 sign and execute the instrument as her LAST WILL, that
DORIS L. BRICKER 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 besvof our
knowledge, the Testatrix was at the time 18 years of ge r mpre//sound mind
and under no constraint or undue influence. /
Sworn or affirmed to and acknowledged before me
this a/� day oof--41�04� , 2011.
Notary Public
_..... ,.._.,_,._,..,,,.M.,,.
rd02F' I ;TEAL.
U!ANE M d+NiH
Noiciy r'u Slic
McCli58URG 8620,CUMBERLgMjCNrf
My Commisslon EXpiros Jun 22,