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Home My WebLink About10-01-07 '* '+,' j ,--, r- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES IN~ITA~E TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 -,INHERITANCE TAX RECORD ADJUSTMENT ;JOINTLYHELD OR TRUST ASSETS 'HI'" I"lr:T - I /. '~..~.1 i U oJ I ill-I !O: II 7 CL~R!< ell: 08:-:';'! ',' i ' ;~ '~:RT ,,",, 1\ DENNIS R SHELLENBERGER - PO BOX 394 LEWISBERRY PA 17339 REV-1604 EX AFP (03-05) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 09-21-2007 SHELLENBERGER 04-17-2006 21 06-0363 CUMBERLAND 180-26-6686 06129126 D SHIRLEY Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1604 EX AFP (03-05) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS -- DATE 09-21-2007 ESTATE OF SHELLENBERGER SHIRLEY D DATE OF DEATH 04-17-2006 CUMBERLAND COUNTY FILE NO. 21 06-0363 ADJUSTMENT BASED ON: S.S/D.C. NO. 180-26-6686 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: SOVEREIGN BANK ACN 06129126 ACCOUNT NO. 1684014440 TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 08-11-2005 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions - Taxable Amount Tax Rate X Tax Due .00 1. 000 .00 .00 .00 .15 .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE 00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, 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.) ~ BUR~AU OF INDIVIDUAL TAXES IN~ITA~ TAX DIVISION PO BOX 2B0601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS *' REV-1604 EX AFP (03-05) DENNIS R SHELLENBERGER PO BOX 394 LEWISBERRY PA 17339 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 09-21-2007 SHELLENBERGER 04-17-2006 21 06-0363 CUMBERLAND 180-26-6686 06129127 SHIRLEY D Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS ~ -......--....-..-..-------..---------..-------...---------.-------.----------------.------....-----------.-.-------.--------- REV-1604 EX AFP (03-05) .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. DATE 09-21-2007 ESTATE OF SHELLENBERGER SHIRLEY D DATE OF DEATH 04-17-2006 COUNTY CUMBERLAND FILE NO. 21 06-0363 ADJUSTMENT BASED ON: S.S/D.C. NO. 180-26-6686 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 06129127 FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO. 1685540138 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 08-11-2005 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 1. 000 .00 .00 .00 .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE 00 /" l"- II IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. " ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) Q YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (6-88) .... ...... '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME REVIEWED BY Shirley D. Shellenberger Eunice Baker FILE NUMBER ACN 2106-0363 06129126,06129127 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The above accounts have been adjusted to zero. The accounts were reported on the probate return. ROW Paqe 1