HomeMy WebLinkAbout12-05-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 018487
BRENNEMAN KEITH O
44 W MAIN STREET
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ----------
101 � $47.99
ESTATE INFORMATION: ssN: I
FILE NUMBER: 2111-1277 �
DECEDENT NAME: MILLER PATRICIA ANN �
DATE OF PAYMENT: 12/05/2013 �
POSTMARK DATE: 12/05/2013 �
COUNTY: CUMBERLAND �
DATE OF DEATH: 06/25/2011 �
�
TOTAL AMOUNT PAID: $47.99
REMARKS: RECEIPT TO ATTY
CHECK# 3532
INITIALS: HMW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
� i ' �.
N�TICE OF INH�RITANCE TAX ; � p.:�nnsylvania
�,�,, APPRAISEMENT, ALLOWANCE OR DiSALLO�IANCE DEP!►RTMENTOFREVENUE
BUREAU oF INDi�I1�►�.'�s ,,,�„OF DEDUCTIONS AND ASSESSMENT OF .TAX
INHERITANCE TAX �IyI.�,j,QN � REV-1547 D( AFP (08-13)
PO dOX 280601 �� ...;1 �'" �"
WIRRISBUR6 PA 1��01 �� � � �: '
t� t,�. � p � � DATE ; 11-19-2013
� �` � . '� . ESTATE OF � = MI�L.LER `�PATRICIA A
� � � � w � � DATE OF DEATH 06-25-2011
,�� � � � .,�Q, t,� � FILE NUMBER ' 21 11-1277
� � � � � COUNTY + CUMBERLAND
BR�f�!IAN�SQ K�� � ACN ° 101
44�1 �AIt�T � APPEAL DATE: 01-18-2014
P� BOX 31$`` �
(See rev�rse side under Objections)
MECHANICSBURG PA 17055-0318 A�ount Re�itted�- � .
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER; OF WILLS
' 1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALON6 THIS LINE � RETAIN LOWER PORTION FOR YOUR RECORDS t-- ___ ______________
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REV-154T EX AFP COS-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DI�ALLOWAN�� 0F D�DUCTIONS -kND- /kSS`�SSMEN-T--Bf TA�C -----
ESTATE OF: MILLER PATRICIA AFILE N0. :21 11-1277 � ACN: 101 DATE: 11-19-2013
TAX RETURN WAS: C�) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estata CSchedulQ A) C1) .0 0 NOTE: To ansu�a proper
2. Stocks and Bonds CSchadule B) C2� 3,5 6 0.6 4 cradit to your account,
.00 subn�it the uppar portion
3. Closely HQld Stock/Partnership Intarest CSchedule C) C3) of this fcrm with your
4. Mortgages/Notes RecQivable CSchedule D) (4) ` .0 0 tax payment.
5. Cash/Bank Daposits/Misc. Personal Property CSchedule E) (5) 1 6,719.3 3
6. Jointly Owned Property CSchedule F) C6� 24,964.57
7. Transfers CSchadulQ G) ��� .0 0
8. Total Assets c8) 45,244.54
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens�s/Adw. Costs/Misc. Expenses CSchedule H) C9� 2,8 0 9.25
10. Debts/Mortgage Liabilities/Liens CSchedule I) C10) 88•939.87
11. Total DQductions �li� 91,749.12
12. NQt Valuo of Tax Return C12� 46,504.58-
13. Charitable/Gove�nmental Bequests; Non-elected 9113 Trusts CSchedule�J) C13� .0 0
14. Net Value of Estate Subject to Tax � C14) 46�504.58�
`NOTE: If an assess�ent was issued previous�y, 'Lines 14, 15, 16, 17, 18 and/or 19 will
reflect �fi�ures that include the total of all return� assessed to date.
ASSESSMENT OF TA�C: ; i
15. A�aount of Lf�nQ 14"at spousal rate - _�- ' C15)
- ---�00- x -00-; _ _ - - .00 _
16. Amount of Line 14 taxable at lineal rate C 16) �G=96G-�� x 045 = 1,123.41
; = 00
17. Amount of Line 14 at sibling rate C17) � _ .�0 X 12 •
18. Amount of Line 1.4 taxable at collateral rate C18) � .00 X 15 ° .00
19. Principal Tax Due C19�= 1,123.41
t
TAX CREDITS: �
PAYMENT ' RECEIPT DISCOUNT C+) AMOI�NT PAID
DATE � NUMBER INTEREST/PEN PAID C=)
08- 8- 0 3 ; CD018074 .00 ; 1,123.41
' �
BALANCE OF UNPAID INTEREST/PENALTY AS UF 08-29-2013 TOTAL TAX PAYMENT 1,123.41
BALANCE OF TAX DUE .00
INTEREST AND PEN. 47.99
TOTAL.DUE 4?.99
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT CCR�, YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.