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Home My WebLink About03-25-11k BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS i .. .. I .. i .. r C~E~~ ~~ JEANNE SOUDERS O~O~~~~ ` ~~r'~~ CIJh~~~ ~ ~°°"~,1 .,... PA. 619 WEST MAIN STREET MECHANICSBURG PA 17055 Pennsylvania ` _ i DEPARTMENT OF REVENUE ~° REV-1504 EX AFP (12-10) DATE 03-09-2011 ESTATE OF FERNBAUGH ANNA M DATE OF DEATH 12-10-2009 FILE NUMBER 21 09-1183 COUNTY CUMBERLAND SSN/DC 101-24-4375 ACN 10102329 Amount Remitted -~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS F~ REV-1604 EX AFP C12-10) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS *~ DATE: 03-09-2011 ESTATE OF: FERNBAUGH ANNA M DATE OF DEATH: 12-10-2009 COUNTY: CUMBERLAND FILE NO.: 21 09-1183 S.S/D.C. N0.:101-24-4375 ACN: 10102329 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO.: 3550-00 TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 10-09-1956 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: .00 X 0.500 .00 .00 .00 X .045 .00 NOTE: TD ENSURE 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 01-26-2010 CD012280 .00 147.28 03-08-2011 REFUND .00 147.28- ^ TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. _ .00 TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~i BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 JEANNE SOUDERS 619 WEST MAIN STREET MECHANICSBURG PA 17055 • ~ , INHERITANCE TAX RECORD ADJUSTMENT pennsy varna ,.~, JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE REV-L504 EX AFP (12-10) DATE 03-09-2011 ESTATE OF FERNBAUGH ANNA M DATE OF DEATH 12-10-2009 FILE NUMBER 21 09-1183 COUNTY CUMBERLAND SSN/DC 101-24-4375 ACN 10102330 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~1 RETAIN LOWER PORTION FOR YOUR RECORDS F~ REV-1604 EX AFP C12-10) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 03-09-2011 ESTATE OF: FERNBAUGH ANNA M DATE OF DEATH: 12-10-2009 COUNTY: CUMBERLAND FILE NO.: 21 09-1183 S.S/D.C. N0.:101-24-4375 ACN: 10102330 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 06-05-2003 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: .00 NOTE: X 0.500 .00 00 .00 X .045 .00 ACCOUNT NO.: 3550-05 TO ENSURE 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 DRDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. _ .00 TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. rev-ia~o ex poi-ion • ~ pe1111$~/~Val11a INHERITANCE TAX DEPARTMENT OF REVENUE EXPLANATION BUREAU OF INDIVIDUAL TAXES OF CHANGES PO Box 280601 -0 1 DECEDENT'S NAME FILE NUMBER ANNA M FERNBAUGH 2109-1183 REVIEWED BY ACN Judy Watts 101102329 & 10102330 ITEM EXPLANATION OF CHANGES SCHEDULE NO. The above ACN's have been zeroed out leaving a zero balance due. These accounts have been reported and paid on the Inheritance tax return. You will receive your refund in 4-6 weeks. Row Page 1