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Home My WebLink About03-05-07 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE R[,r;(':,~r:r'l nJQtU'fAHCE TAX ~;-::':',-':-.teO~ ADJUSTMENT ~ijO,tNirt'Y,HE(JblJR TRUST ASSETS * <t . ..... , BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280&01 HARRIS8URG PA 17128-0601 REV-1604 EX AFP (03-05) 2007 rMR -5 PH /. 2 pATE . /ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN SUELLEN K HAHN 612 LYMAN AVE WOMELSDORF ClER!< OF ORPI-."~N',c;, ('n, ' ',nT C'I,' ",.-:" '. '.""IJll \...1 i'v';' " ,"" ," i~""\. PA 19567 02-26-2007 BURKETT 09-16-2006 21 06-1063 CUMBERLAND 194-24-2208 06159506 F JANE Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ CUT ALON8 THIS LINE ______..1>. ..__________ _....___.__ tilll."'-l>. ..._ REV-1604 EX AFP (03-05) .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. DATE 02-26-2007 ESTATE OF BURKETT JANE CUMBERLAND F DATE OF DEATH 09-16-2006 COUNTY ACN 06159506 FILE NO. 21 06-1063 ADJUSTMENT BASED ON: S.S/D.C. NO. 194-24-2208 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 203464-40 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 08-31-2005 Account Balance Percent Taxable X A.ount Subject to Tax Debts and Deductions Taxable A.ount Tax Rate X Tax Due .00 0.166 .00 .00 .00 .45 .00 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE RE8ISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "RE8ISTER OF WILLS, A8ENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-14-2006 CD007571 .00 239.26 TOTAL TAX CREDIT 239.26 BALANCE OF TAX DUE 239.26CR INTEREST AND PEN. .00 TOTAL DUE 239,2l>CR . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN n, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) 1 , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE i~~ijl}tl~I~~T JOINTL~!-H~LD :O,R r~UST ASSETS *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO lOX 210601 HARRISIURG PA 17121-0601 REV-160~ EX AFP (03-05) SUELLEN K HAHN 612 LYMAN AVE WOMELSDORF ZGG7 ~M.R - 5 ~~~f.? hF DATE OF DEATH CLERi< :]fUE NUMBER ORP,-"q,I'C: ~Y " ,1-'''-,'',1\ u ',j" ~ ell> ,-"-,, ,,-, t". ;1 ;::. "" ';... , .7'\ jl', ACNh 02-26-2007 BURKETT 09-16-2006 21 06-1063 CUMBERLAND 194-24-2208 06159508 JANE F A.aunt R..1 tted PA 19567 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONS THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS +- __._______ .._ l'If""<flf ....._.___ REV-l'04 EX AFP (03-05) .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. DATE 02-26-2007 ESTATE OF BURKETT JANE F DATE OF DEATH 09-16-2006 COUNTY CUMBERLAND FILE NO. 21 06-1063 ADJUSTMENT BASED ON: S.S/D.C. NO. 194-24-2208 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 06159508 FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 203464 -45 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 08-31-2005 Account Balance Percent Taxable X A.ount Subject to Tax Debts and Deductions Taxable A.ount Tax Rate X Tax Due .00 0.166 .00 .00 .00 .45 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE RESISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "RESISTER OF WILLS, ASENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-14-2006 CD007567 .00 222.81 TOTAL TAX CREDIT 222.81 BALANCE OF TAX DUE 222.81CR INTEREST AND PEN. .00 TOTAL DUE ??? Rlt".1l * IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN U. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). t1 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) '-1) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ,rr_l~'UTANCE TAX vRECORDADJUSTMENT C:I~'O~Nl'lY'HELP OR TRUST ASSETS *' . f . ,-' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280&01 HARRISBURG PA 17128-0'01 20GH1t\R -5 Pr1 I: 21 SUELLEN K HAHN 612 LYMAN AVE WOMELSDORF CI ETlj< (-c __r.., JI ORPH f.' l,r. ('11 IR.. T ,,'-\.I\!~ "j",,, I cu'~r'..--,' '1'-, n pI lIVl:".,. ,: - ,; '".,'!, !-','~ PA 19567 REV-l'04 EX AFP (03-0S) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 02-26-2007 BURKETT 09-16-2006 21 06-1063 CUMBERLAND 194-24-2208 06159510 F JANE A.ount R..1tt.d MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 +- ... RETAIN LOWER PORTION FOR YOUR RECORDS 11.______________________. .& CUT ALON~ THIS LINE REV-l'04 EX AFP (03-05) .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. DATE 02-26-2007 ESTATE OF BURKETT JANE CUMBERLAND F DATE OF DEATH 09-16-2006 COUNTY ACN FILE NO. 21 06-1063 ADJUSTMENT BASED ON: S.S/D.C. NO. 194-24-2208 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU 06159510 ACCOUNT NO. 203464-41 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 08-31-2005 Account Balance Percent Taxable X A.ount Subject to Tax Debts and Deductions Taxable A.ount Tax Rate X Tax Due .00 0.166 .00 .00 .00 .45 .00 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE RE~ISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-14-2006 CD007566 .00 142.79 TOTAL TAX CREDIT 142.79 BALANCE OF TAX DUE 142.79CR INTEREST AND PEN. .00 TOTAL DUE 14? 7Q~R . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Db BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280'01 HARRISBURG PA 17128-0'01 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE (Ci:!('J'H.HERITANCE TAX " '-.' I RECORD ADJUSTMENT 'iJ(J~-"T~Y ~ELD OR TRUST ASSETS *' .. I . to.'. SUELLEN K HAHN 612 LYMAN AVE WOMELSDORF 2007 MAR - 5 PH I: 2 I CLERi< OF ORPH4{11'C: r{'il fry, elJ' ..~' .-:. ' . u "jj(Jrr J i,.'...., ; ';1 Jr.... ie' : ': PA . ;, PA 19567 CUT ALONa THIS LINE REY-l'04 EX AFP (03-05) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 02-26-2007 BURKETT 09-16-2006 21 06-1063 CUMBERLAND 194-24-2208 06159512 F JANE A.aunt R..1tt.d MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ... RETAIN LOWER PORTION FOR YOUR RECORDS +- ---------_..__.~ .....------.........- REV-l'04 EX AFP (03-05) .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. DATE 02-26-2007 ESTATE OF BURKETT JANE CUMBERLAND F DATE OF DEATH 09-16-2006 FILE NO. 21 06-1063 ADJUSTMENT BASED ON: COUNTY S.S/D.C. NO. 194-24-2208 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACN 06159512 ACCOUNT NO. 203464-47 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 08-31-2005 Account Balance Percent Taxable X A.ount Subject to Tax Debts and Deductions Taxable Allount Tax Rate X Tax Due .00 0.166 .00 .00 .00 .45 .00 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REaISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-14-2006 CD007568 .00 73.65 02-26-2007 REFUND .00 73.65- TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .OD TOTAL DUE ,nn ...... 6 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. U ( IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1lf70 EX, (e.er;) I '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDMDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Jane F Burkett REVIEWED BY Department of Revenuel Teresa Selders ACN 2106-1063 06159506, 08,10,12 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Above-referenced ACN{s) are being adjusted to reflect zero tax due since they have been reported on the probate return. ROW PaQe 1