HomeMy WebLinkAbout01-09-79
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1lCC-33 (4-73)
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COMMONWEAL TH OF PENNSYLVANIA _~~
BUR~~~A~~~~~~i~~i~~g;IONS C\ \~1~ ~
c:2/- 7Y-Clf2.3
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORTANT;
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Reltenue. <Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
} AFFIDAVIT OF
EXECUTORS
.._...-....w.
~EROY H. BRICKNER
(STATE FULL NAME OF DECEDENT)
Late of
So.Middleton Twp.,Oum~lmd
County
Stote of
Pennsylvania
Cumberland
Paul L. Brickner
} 55:
County of
,..,iIliRt...
and Donald L. Brickner
ExecutorS
of the estate of the above-named decedent being duly sworn, depose
and .oy
Decedent di ed
1
, 19~J t..tot. leaving 0 lo.t will, copy of which I. hereto ottaChed,,}
(y EAR) \,milHlJC
August
I,MONTH\
Name and address of attorney or }
other authorized repres,entative to whom
all correspondence sho,d!: "::I.
(DAY)
William F. Martson, P.C.
10 East High Street, Carlisle, PA
17013
ThaI as such~xecutors deponent is familiar with the affairs of said estate and the property constituting
( EXECUTOR-~XXOl!~
the as sets thereof and their fair market value,
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SA.FE DEPOSIT BOX
Commonwealth Nationa Ban
One North Hanover Street
Carlisle, PA 17013
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
on
That the contents of said safe deposit box or boxes are itemized under Schedules A . B ,if this return,
wi th the exception of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein, It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings. treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state. or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all n-";dl~l1e. d.l-'pafl,;~, jc;Wtl1Y, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promis sory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the facc value and estimated fair market value thereof, and if such estimated fair. market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which we' ,ayable upon the death of the decedent; all and the corporate stocks and- dividends
due thereon and unpaid 3.S of 11-, date of dealh, bonds and accrued interest thereon to the date of decedent's
death and other investment s~C' '!;cs owned by the decedent at the time of death, with the'market value there-
of at such time.
In the case or securities of close or ramily corporations, the values reported are as rar as
possible substantiated by rinancial statements of the corporations, showing the assets and liabilities
thereor as of the date of death. The schedule also sets forth the interest or decedent at the time or
death in any co-partnership or business, and in support or the value or such interest there is annexed to
said schedule, rtnancial statements showing the assets and liabllities or said co-partnership or D,usiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature or Hie agreement)
together with a statement setting rorth the character or the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal or the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the ritir market value
thereof, any other property owned or bequeathed by, the decedent at the time of death.
.,
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers orproperty, real or personal, within two years of decedent's
death, in contemplation or decedent's death, '-.or intended to take erfect in possession or. enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transrerred, the
relationship or the transrerees to the decedent, the proportionate share received .by each transfe.ree ~d
all other racts or a pertinent nature regarding said transrers. In the case or transfers intended"to
take errect in possession or enjoyment at or arter death, there is also attached to the schedule a CORY
or the deed, trust agreement or other instrument crsating the trust. Ther.. is also set rorth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually, ow jointly with another, or any power or appoint-
ment vested in decedent, et ther indivtd~al1y or jointly, by the will, deed, or other instrument of another,
wi th a copy or the instrument creating such power attached to the schedule.
That Schedule 0 attached hereto and made part hereor sets forth the names and addresses or all
persons benericially interested in this estate at the time of decedent's death, the nature or their res-
pective interests, their relationship, ir any, to the decedent, together with the ages at the time or
decedent's death of all minors, annuitants and benericiaries ror life under decedent's Will. It also
contains a statement showing which of the benericiaries named in the decedent's will, if any, died prior
to decedent, the dates or their death, their issue, and the relationship of" such issue to the bener1ciary.
That Schedule E attached hereto and made a part hereof sets rorth all property, real and per-
sonal, owned by the decedent jointly. with anot-ner OJ' others, including intangible, standing in ..the name
or the decedent and others, plus ,tbe,.date and place. or record or instruments. errecting the vesti.ture of
real estate and the date of" acquisition or person~~ty, plus the name, address and relationship, ir any,
of" co-owners to the decedent.
That Schedule F attached hereto and made a part hereor sets rorth f"ully and in detail all debts
and deductions claimed. ror and on behalr or this decedent's estate, including f"uneral expenses paid;
f"amilyexemption, where applicable; costs or administration of this estate; counsel rees and f"udiciary's
commissions paid or to be paid; cost expended ror burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence or the death or the decedent; debts and claims owing and unpaid at time or
death; taxes accrued chargeable f"or period prior to decedent's death (except those allowed under Section
6~1 of the Inheritance and Estate Tax Act); together with a statement or collateral pledged ror obliga-
tions, ir any. It is agreed that the f"iduciary will present proor of" said claimed obligations upon re-
quest, that ir the amount actually paid in settlement or any ree, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of" Wills, and that
the amount of" tax assessed can be reassessed in accordance therewith.
That the totals or the appropriate columns in Schedules "A", "B", "CO, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ................................ tR - - ./:;;tP ~: L~- .J
.............................9!.~..f!' ...... day of ....~................... 19;.f...... ~=:lLD...I.W~..4."'.~.. ............................
.........................~...~....~.......~.......,.................................. lQ.....E~~:.~~~~~~=~............................_..._.._..
,^^k1' U.A~!iENJ)"_.:,"y P'*"C (Street Number)
Q.rli.lv, Cumbi'rlar.d Co., PA C~.:r..l.i.~..l.e...*.....f..A.........l..7..Q.l.~.....................................................
My ~5Sjan bpkwFab. :0, 19S. (City or Town and Sto.te)
NOTE: Before signing af"fidavit make sure all blank spaces in the arridavit and schedules annexed are
rilled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities or close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
,
RCt-34 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMI:NT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
"RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
-
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant jn common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E,")
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street and street number, together with
a general description of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm state number of a-
cres; also statement of mortgage encumbrance. upon each parcel at death
of decedent. Tax.., a....sments, accrued Inter..t on mortgag.., ate.,ar.
to be listed on Schedule "F" and mu.t not be deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUA TION
CAUTION
(Do not wrIte
In this spaco)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
1. ALL THAT certain lot of ground with
the improvements thereon erected, located
on the North side of the public highway
leading from Carlisle to York in South
Middleton Township, Cumberland County,
Pennsylvania, being known and numbered as
215 York Road, and being Lot No. 3 in
Block "I", bounded on the South by the York
Road a distance of 50 feet and extending in
depth at an even width for a distance of
150 feet, as appears on the Plan of Car1ise
Manor, recorded in the office of the Record r
of Deeds of Cumberland County, Pennsylvania
in Plan Book 3, Page 79.
BEING the same premises which Ray M.
Paxton and Arlene L. Paxton, his wife, by
deed dated May 1, 1953, and recorqed in the
office of the Recorder of Deeds in and for
Cumberland County in Deed Book "I",
Volume 15, Page 31, granted and conveyed
unto Leroy H. Brickner and Olive H. Brickne ,
his wife. The said Olive H. Brickner
having died August 28, 1973, title was
vested entirely in the said Leroy H.
Brickner.
SAID PREMISES were sold to Emerson G.
Hoover and Anna F. Hoover, his wife, at
public auction on September 21, 1978, for a
price of $29,000.00, and conveyed
October 13, 1978.
ASSESSED VALUE:
Land:
Building:
Total:
---
$5,560. 00 ~29 .000. O~ "Z-~ \ot)o ,D 0
$ 990
4570
$5560
Insert this total opposite "real propedy", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
$ 2 9 , 000 . 00 '2.. q '} 00 \) . () ,0
LA W OffiCES
1I/$tUlt $<., tftU/jO/l,
.9<t:
HENDERSON BLOCK
TEN EAST HIGH STREET.
CARLlSLE, PENNSYLYANIA 17013
AREA CODE
717
243.3341
MEMORANDUM..OF. SETTLEMENT
Date of Settlement ~tohf'r 13_1218 Assessed Valuation $ ~-,O3_60. 00
Sold By Executors oX~hg~Estate Qf Leroy H. Brickner
Sold To Emerson G. and AnnaLHoover
Location of Property 215 York Road, South Middleton TownshiJ?-Lu
Cumberland County, Pa.
Purchase Price ...................................
Down Payment ...................................
Balance ... ................... ....... ......... ........
$ 29,000 OD_
$ 2,900.00
$~lDO.OO
Balance paid as follows:
$_316,109.00 - Due Estate
$ 360.77 - Less E~enses
$ $25,739.23
$
$
$
Prorate of Taxes:
School $ 305.80 ~unpai~
from ~~1/78
To 10/13/78
County I road I Borough $ 66. 72
from 10/13/78
To 1/1/79
seller to buyer ..~.........
Total paid by buyer to seller ..............
Chcck List:
$ 87.98 (Seller owes)
(65.39) Pd.4/17/78 $22.24 Twp. (21.80)
(87.63 Pd.)
$
19.21
68.77
(Buyer owes)
$
Water Rent
Sewcr Rent
Mllnicipal Assessments
Gas Bill
Electric Bill
Special Asscssments
Insurance-(Assigned, cancelled)
. .
FEES AND EXPENSES TO BE BORNE BY
SELLER
BUYER
Recording of Deed. . . . . . . . . . . . . $ ___2tot2___
Recording of Mortgage........... $ -------
Acknowledgements............ $_______
Transfer Tax. . . . . . . . . . . . . . . . . . $_~fo. Oc::._
Tax Proration ................ $- ----
Title search, including settlement. . $~.f">: {jfl_
----- $---
-------.-. $------
----- $
$--
$---
$
$
$
$
$
Total $ 49?'tJd
Realtor's Commission .......... $ -- . -- - -. -
Tax Proration. . . . . . . . . . . . . . . . . $_ _. . 1)_8.1 L
Acknowledgement. . . . . . . . . . . . . $.__2_,-Q~
Satisfaction of Mortgage. . . . . . . . . '$
Transfer Tax. . . . . . . . . . . . . . . . . . $_ ..1.90 J!9_
Preparation of Deed and settlement $___._
_._-_._--~--- $--.-----.--
.-.- .--.-----.----- $.---.--------
-..--., ---------.---- $.-------- _..-
._------------ -- $-------------
-- $
$------
$
$
$
$
Total $ $360.J7
.. .
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible a.ndintangible personal property owned indiVidually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tent&-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stOCkS, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT ESTIMATED
VALUE MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
Proceeds from public sale of household
goods, September 21, 1978
1974 Chevrolet Sedan, Title No.C25347070,
Vehicle Identification No.lY69D4W187284.
Sold to Laura V. Thomas at public auction
September 21, 1978.
Certificate of deposit No.6685685,
Cumberland Valley Savings and Loan
Association, registered in name of
decedent.
Balance at date of death
Accrued Interest to date of death
4. Full-paid passbook account No. 93154,
Cumberland Valley Savings and Loan
Association, registered in name of
decedent.
Balance at date of death
Accrued Interest to date of death
$ 5,040.1
1.
2.
3.
21,500.0
119.01
'2-\) Soo. 00
llC{.D\
5.
171 shares, common, Farmers Trust Company
Certificate No. 5980, registered in name
of decedent. 32.50
Medicare Refund (H.Robert Davis,M.D.)
Medicare Refund (Harris Associates)
Refund, United Telephone Company
Medicare Refund
Proceeds, Prudential Life Insurance
Company, Policy No. WSH-04384448,
Olive H. Brickner, Deceased, Beneficiary
Erie Insurance Company, Refund on
Homeowners Policy
<S) 5'5"1. So
lCc,l.(."o
314.. () (;)
4. sf.:.
""1.00 -
6.
7.
8.
9.
10.
l\ ooo-()O
11.
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X $40,579.39 40,51'1,'3'1
CUMBERlAND
~llEY ~I~
AND LOAN ASSOCIf::>.,J1ON
16 West High Street. Carlisle. Pennsylvania 17013 249-2525
August 10, 1978
William F. Martson, P.C.
William L. Earp
Estates Administrator
Henderson' Block
10 East High Street
Carlisle, PA 17013
Gentlemen:
We have received the short certificate on the Estate of
Leroy H. Brickner.
As you have requested; listed below is the balance of
his accounts as of the date of his death, August 1, 1978.
Certificate of Deposit # 6685685 Balance
Accrued interest
Full Paid passbook account # 93154 Balance
Accrued interest
:p
If you have any further questions, please contact our
office.
Sincerely yours,
f{fuuz ~
Janet Keller
Head Teller
.
RCC-3(>
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
'*
RESIDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) NO
(2) Did decedent, within two years of death, transfer propercy from hims~tt to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) y~S
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer 79
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no)-1iCL______
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) NO
(b) What was the transferee's age at time of decedent's death?
(ti) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) NO
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) NO
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) NO
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which conld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) NO
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If anSwer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
1. United States Savings Bonds, Series "E",
various denominations, issued August 1949
in the names of Leroy H. Brickner and
Olive H. Brickner. Olive H. Brickner
having died August 28, 1973,ownership
vested entirely in name of Leroy H.
Brickner. On May 11, 1978, said bonds
were registered to the co-ownership of
Leroy H. Brickner and Paul L. Brickner,so .
Denomination Serial Number
$1,000.00 M 208 167 l89E $ 2,439.6 .~... Ll '3 tt. b 0
1,000.00 M 208 167 190E 2,439.6 , ""2..,4.3<1."-0
1,000.00 M 208 167 19lE 2,439.6<Y "2-., Ll3'i.lo 0
""2- 1 '-t 3<(.<'0 (:>
1,000.00 M 208 167 192E 2,439.6 -z. ... u. 3t't . 10 0
1,000.00 M 208 167 193E 2,439.60,/'
1,000.00 M 208 167 194E 2,439.6 L-~t..(?'Cc.bO
1,000.00 M 208 167 195E 2,439.60/ """2-, Lt3"i..1;...0
1,000.00 M 208 167 196E 2,439.60/ "'Z ') Ll 3'1. . ~ =
1,000.00 M 208 167 197E 2,439. 60~. 2-, U;,'t.lc.o
1,000.00 M 208 167 198E 2,439.60, '2-., \.(""3 'i, Co 0
1,000.00 M 208 167 199E 2,439.60 '2.,Lt3ct..~u
1,000.00 M 208 167 200E 2,439.60
200.00 R 208 639 286E 487 . 9~ 4 'ar ,<("'"2....
100.00 C2067 750 067E 243.9 . L.J.(;, . C( \..
50.00 L2129 473 215E 121. 98' ~L.\ .C(<B
25.00 Q6262 824 377E 60.9 tao,ql{
TOTAL 30,190.05 '2>0') '.'to .DS-
Insert this total opposite "TranSfers", Schedule "C" in the
"As Reported" column on the last page of this return.
llCC-37 (12-63)
COMl'tION\\'EALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
I RELATIONSHIP I
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
'State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
aye an interest, vested, contingent or other' are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
-Kthe1 T Warnpr Da~hter YES 1/5 of residue, per
351 York Road Par~raph 2 of said
Carlisle, PA 17013 Will
~aul L..-- Brickner Son YES 1/5 of residue. per
780 Lonas Gap Road Paragraph 2 of said
Car1isle~ PA 17013 Will
-"azp.1 R r.Qnl':!lQr Da_ughter YES 1/5 of re'sidue, per
R. D. 5. Box 199A Par~raDh 2 of said -
Dillsburg PA 17019 .----..------- Will
,-
Dnnald 1. Rr; .1. Son YES 1/5 of residue, Eel:_
R. D. L .Box _314 Paragraph 2 of said
--
Carlis1e.1 PA 17013 Will
-----....--
~---
Bettv A Nailor Daughter YES 1/5 of residue. per
-
R. D. 1. Box 151 Paragraph 2 of said
Carlisle. PA 17013 Will
---'--~
\
h
Jeponent further says that all the above-named benericiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
(Executor-Administrator
must complete "As
Reported" column #1.)
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~IA TIER OF THE APPRAISEMENT
OF THE
ESTATE OF
Deceased
Late of
County of
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
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RC C-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
with another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated tmder Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
'"
"
').
.xv"
v
8x
.x
1.
Checking Account No. 182-182622- ,
Commonwealth National Bank,
registered in the names of
Leroy H. Brickner and Ethel
Warner, daughter. Ethel Warner
was added to the account
May 10, 1978.
Balance at date of death:
$9,754.57
Full
~/
$9,754..-7
2.
Certificate of Deposit
No. 18-3589, Commonwealth
National Bank, 7-1/4%, registerec
in the names of Leroy H.Brickner
or Paul L. Brickner, dated
August 2, 1975.
Balance at date of death:
$15,000.00
Accrued Interest 36.29
One-half
One-half
7 ,500.0~
18.15
07.272. n
tl, L.17.. .1'i
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
Commonwealth 11.. "'....
National Bank ~~
August 17, 1978
William F. Martson, P.C.
Henderson Block
Ten East High Street
Carlisle, Pa. 17013
Re: Estate of Leroy H. Brickner
Dear Mr. Earp:
In reply to your letter dated August 9, 1978 on the above estate, the
following information is listed below as of August 1, 1978:
Checking Account - #182-182622-7
$9,754.57
Joint with Ethel Warner
Certificate of Deposit - #18-3589
Prine. - $15,000.00
Interest - $36.29
Joint with Paul L. Brickner
If you have any questions, please feel free to contact us.
Very,tru1y yours,
~. :-.://~,<'//~<-'-7/.. /'
,/C.#'1:"?7 L. - / C/1;
Daryl S. Myers ,:7\.
Vice President
DSM/cg
The Commonwealth National Bank, 10 South Market Square, Harrisburg, Pa. 17108 (717) 564.9500
REv-stS (S-'8)
~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPL Y PLEASE
REFER TO
'*
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Paul L. Brickner Donald L. Brickner
780 Longs Gap Road R. Do #1, Box 314
ClIl"l1818 , p~ 17Ol3 c>>"".; .'., 'PA , 70' 3
(Executor or Admini s tra tor)
In Re: Estate of
Lsrcq H. Brickner
Cumber1andCounty - File No.
21-78-0423
Dear Hro Brickner:
You are hereby notified that the Or; gi n..'
appraisement in the estate of 1...."1 H. Bri "knAr
has been filed in the office of the Register of Wills of CumMrbnd
County an March ]9 , 19-'19.., Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
~9,OOO.OO
ita. ~']q.~
'30.190005
17.272072
Ill7.042.16
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L 373.
.1.--
,Q ~,(i " '_" ",-,-~-j
Date March 19, 1979 Signed ,,', C:> "- '--'
, J ,-~/j
Title
Administrative Officer
(
,
'~
"
Note: This is not a bill.
REV-457.(8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P,O, BOX 2970
HARRISBURG, PENNA, 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILE NO.
March 19. 1979
Cumberland
21-78-0423
Whereas, Leroy H. Briclmer late of South Middleton Township
in the County of CnmhltT'l And Commonwealth of Pennsylvania, having died on
the 1st day of August 19 78 ,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo FullZ:initi ,an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT APpraisement
VALUES Made for Inheritance
Tax Purposes
R....' ~ $ 29.000
t.... 00
Personai Property 40,579 39
Transfers 30.190 05
Joint-Held Pronert" 17,272 72
TOTA.L ASSETS : 1117.042 16
.
.
.
,
Have been duly sworn according to law, I do hereby cl3{~.' that thubove ap.pr ril_.isemint is made in c.onfor~ty
with the law on this 19th day of ~_}C" \?u' n ~ch, ..;j~ 19 .
)
Appraiser
Harrisburg
(Numbef and Street)
(Post Office)
, Penna,
A.)~? E -Ll~3
.."...' ..,.,.., ,.. !:;w.!I9~*},.!'m~......... ,........... County
RESIDENT INHERITANCE TAX APPRAISEMENT
Esta te of
,...,",...".......,.~I,"',!..~.~~"..,',.,""',..,
Deceased,
Late of
.." ,.", "" ",.'" ,.$.o.V..t:.\I."m.(I.~.,~,9P.. ,:.r.9~"Jgl'",.
Date of Death, .......,?::k,?,~............,...............,
Appraisement Docket Vol., ,.J:..9...........Y?..~I.IJ,....
Page,......J:7.a,..,........,..... No, ,..,..9.........,.."....
.,."...".",."",.""..".".""""",...""",.."".",.,..,
Filed in Register's Officer ......~~~..~9., 19..7J
Amount of tax due, $..:....................................
DEPARTMENT OF REVENUE
Received, ,." ",', '" ".. ,.. "",'..', ",..."",..." "" '" ",.,
.........................................................................
Examined and Approved, .........................,..,...,
Wrote about Appraisement, ......,..........,...........
Appeal from Appraisementr .............................
Entered and charged, .,.....,.....'........................,