HomeMy WebLinkAbout05-08-14 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 019130
BROWN CHUN
786 FIRE BREAK DR
CLARKSVILLE, TN 37040
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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'__"'____ """"
14120761 � $85.71
ESTATE INFORMATION: sstv: � I
FILE NUMBER: 2114-0366 I
DECEDENT NAME: BROWN PIL SAENG I
DATE OF PAYMENT: 05/08/2014 I
POSTMARK DATE: 05/08/201 4 I
CoUNTY: CUMBERLAND �
DATE OF DEATH: 03/09/2014 I
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TOTAL AMOUNT PAID: 585.71
REMARKS:
INITIALS: HMW
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax • enns�/lvania
PO BOX 280601 y � J
HARRISBUR6 PA 17128-0601 II1fOCIlIatlOfl NOtIC@ DEPARTMENT OF REVENUE
And Taxpayer Response REV-1543 E%Oo<ESE (OB-12)
FILE NO.21 '°�" �� '—�� �
ACN 14120761
DATE 04-21-2014
Type of Account
Estate of PILSAENG BROWN Savings
SSN 195-50-1208 Checking
03-09-2014 Trust
CHUN H BROWN County CUMBERLAND Certificate
23 WILD ROSE LN
MECHANICSBURG PA 17050-1666 � N
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PNC BANK NA provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.5112690168 Remit Payment and Forms to:
Date Established 10-24-2011 REGISTER OF WILLS
Account Balance $4,285.41 1 COURTHOUSE SGIUARE
Percent Taxable X 16.667 CARLISLE PA 17013
Amount Subject to Tax $714.25
Tax Rate X 0.120
Potential Tax Due $85.71 NOTE': If tax payments are made within three months of the
decedenYs date of death,deduct a 5 percent discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE*) due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART Step 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
g �The information is The above information is correct, no deductions are being taken, and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select correct tax rate at
right,and complete Part � 12qo I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Comp/ete Part 2 and part 3 as appropriate on fhe back of this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.