HomeMy WebLinkAbout03-19-15 Jpennsylvania 1505618627 3M464710.000
DEPARn NTocAEvENUE EX(03-14)(TP)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN I r
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 'J
v
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
10142014 03061937
Decedent's Last Name Suffix Decedent's First Name M I
BRICKER ROBERT C
(if Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
BRICKER MARTHA W
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. Agriculture Exemption(date of F-1 5. Future Interest Compromise(date of D 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
El7. Decedent Died Testate 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received 11. Non-Probate'Transferee Return 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
F] 13. Business Assets FE 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARTHA W. BRICKER 717-766-4543
First Line of Address
94 BRINDLE ROAD
Second Line of Address
City or Post Office State ZIP Code
MECHANICSBURG PA 17055
Correspondent's email address:
REGISTER OF WILLS USE ONLY v
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY
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DATE FILED STAMP 9 r�
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PLEASE USE ORIGINAL FORM ONLY C )
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Side 1
I IIIIII(IIII IIIII IIIII IIIII IIIII ILII IIIII IIIII ILII IIII IIII
1505618627 1505618627
1505618635
REV-1500 EX(TP)
Decedent's Social Security Number
Decedent's Name:BRICKER ROBERT C
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 . 00
2. Stocks and Bonds(Schedule B) , , , , , , , , , , , , , , , , , , , , , , , , , 2. 3 6 • 4 0
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). 3. 0 • 00
4. Mortgages and Notes Receivable(Schedule D) . . . . . . _ , 4. 0 • 00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E), , , , , , 5. 0 • 00
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested. . . . . 6. 0 • 00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) 1-1 Separate Billing Requested. . . . . 7. 4 4 4 ,6 8 5 • 80
8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 4 4 4 ,7 2 2 • 20
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 31515 • 00
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1), , , , , , , , , , 10. 0 - 00
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 3-,515 - 0 0
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12 441,207 • 20
13. Charitable and Governmental Bequests/Sec.9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 0 • 00
14. Net Value Subject to Tax(Line 12 minus Line 13), . , . , . , , , , , 14. 441120? • 20
TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers uWer Sec.9116
(a)(1.2)X.0_ 4411207 . 20 15. 0 . 00
16. Amount of Line14xable
at lineal rate X.044- 0 . 00 16. 0 . 00
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. 0 . 00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT El
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 person responsible for filling the return is based on all information of which preparer has
any knowledge.
SI NAW E. OF F PERO RF ONSIB 9 NG RETURN Dt
ADDRESS
MARTHA W• BRICKER 94 BRINDLE ROAD, MECHANICSBURG, PA
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE_FOR FILING THE RETURN DATE
ADDRESS
IIIIIIIIIIII�IIII'llllI'IIIII III' IIIIIIII�IIIIIIIIIII IIII Side 2
15056863 1505618635
3M464810.000
REV-1500 EX(TP) Page 3
File Number
Decedent's Complete Address:
DECEDENTS NAME
BRICKER ROBERT C
STREET ADDRESS
ROAD,94 BRINDLE 0 RO TWP
CUMBERLAND
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0 . 00
2. Credits/Payments
A. Prior Payments 0 . 00
B.Discount 0 . 00
(See instructions.) Total Credits(A+B) (2) 0 . 00
3. Interest
(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
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Elb. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . . . . . ❑ 0
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . ❑ ❑X
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . . . . . ❑
2. If death occurred after Dec. 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 ❑
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 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 step-parent 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.
3M4671 4.000
REV-1503EX,(8,12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert C. Bricker
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. U.S. Saviings Bond 36.40
series EE, $50.00 face value (see attached valuation)
TOTAL (Also enter on Line 2,Recapitulation) $ 36.40
2W4696 2.000 If more space is needed,insert additional sheets of the same size
REV-1510 EX+(08-09) SCHEDULE G
pennsylvania
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert C. Bricker
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NWEOFTHE TRANSFEREE,THEIR RELATIONSHIP TODECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE
NUMBEF THE DATE OFTRANSFER ATTACHACOPYOFTHE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IF APPLICABLE VALUE
1 AXA 444,685.80 100.0000 0.00 444,685.80
IRA account #306 616 210.
Designated beneficiary is
decedent's surviving spouse .
TOTAL(Also enter on line 7,Recapitulation)$ 444 685.80
If more space is needed,use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert C. Bricker
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
None
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP-
Year(s)Commission Paid:
i
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500.00
Claimant Martha W. Bricker
Street Address 94 Brindle Road
City Mechanicsburg State PA ZIP 17055
Relationship of Claimant to Decedent SURVIVING SPOUSE
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Register of Wills
filing fee for Inheritance Tax Return 15.00
TOTAL(Also enter on Line 9,Recapitulation) $ 3,515.00
3W46AG 2.000 If more space is needed, use additional sheets of paper of the same size.
'
'~~^~ '~`' ^ ENTER-TOTAL-NON-TAXABLE DISTRIBUTIONS
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 10/2014
Total Price Total Value Total Interest YTD Interest
25.00 $36.40 $11.40 $0.30
Bonds: 1-1 of 1
Issue Next Final Issue Interest Value Note
Serial # Series Denom Date Accrual Maturity Price Interest Rate
L595180807EE EE $50 04/2001 11/2014 04/2031 $25.00 $11.40 1.42% $36.40
Totals for 1 Bonds $25.00 $11.40 $36.40
Notes
NI Not Issued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earning interest
http://www.treasurydirect.gov/BC/SBCPrice 3/5/2015