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Home My WebLink About04-1035COY~ONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TARES DELLA A COSEY q06 g SIDDONSBURG RD DILLSBURG PA 17019 'O4 ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE IFILE NO. 21 '~q- ~ ACN 0qlq1391 DATE 10-20-200~ TYPE OF ACCOUNT EST. OF iRUTH C HARBOLD []SAVINGS S.S; NO. 210-$2-7519 []CHECKING DATE OF DEATH 07-10-200q D TRUST qpNT~. CUMBERLAND I~ICERTZF. /Z ~: :;]6 REHZT PAYHENT AND FORMS TO: REGISTER OF gills CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 COMPLETE PART I BELOg ~ ~ # SEE REVERSE SIDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Account No. 1~8777-11 Dmte 12-ZZ-1999 Established Accou~ Balance 1,058.01 Percent Taxable X S0. 000 Amount Subject to Tax 529.01 T~ R~e X .0~5 Po*en*i~1 Tax Due 2~.81 PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART Tf you indlcete a different tax rate, please state your ] relationship to decadent: TAX RETURN - COMPUTATION OF TAX ON JOTNT/TRUST ACCOUNTS 3 x ¢'"~0. LINE 1. Dele Established 2. Account Balance 3. Percent Taxable 4. A~ount Subject to Tax $. Debts and Deductions PAYEE PART DATE PAID DEBTS AND DEDUCTZONS CLAZM£n DESCRIPTION TOTAL (Enter on Line S of TIx Coeputation} $ ~. Ol ~der penalties of perjury, I declare that the flits I have reported above are true, correct and GENERAL ZNFORNATION 1. FAZLURE TO RESPOND WZLL RESULT ZN AN OFFZCZAL TAX ASSESSHENT with applicable interest based on information REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE TAX RETURN - PART 2 - TAX COMPUTATION CLAIMED DEDUCTIONS - PART 5 DEBTS AND DEDUCTIONS CLAIMED CO#HONk~ALTH OF PENNSYLVANIA DEPARTHENT DF REVENUE BUREAU OF INDIVIDUAL TAXES DELLA A COSEY 406 # SIDDONSBURG RD DZLLSBURG PA 17019 '04 ~,~, ]2 Ctn k. ZNFORHATZON NOTICE AND TAXPAYER RESPONSE I PZLE NO. 21 ACN DATE 10-20-2004 TYPE OF ACCOUNT EsT. OF RUTH C HARBOLD []SAVINOS S.:S. NO. 210-52-7519 F"-ICHEC~IN6 DATE OF DEATH 07-10-2004 []TRUST COUNTY CUNBERLAND I~ICERTZF. ~? :~6 R£HIT PAYM£NT AND PORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 COHPLETE PART I BELOW # ~ # SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS Account No. 148777-00 Percent T~xmble X 50. 000 PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY You must complet. PART [] and/or PART []betoN. PART If you indicate a different tax rate, please state your TAX RETURN - COHPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS 7 ~ 8 0, c70 $. Percent Taxable ~. Amoun~ Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due DEBTS AND DEDUCTIONS CLAZHFn DESCRIPTION TOTAL (Enter on Line $ of Tax ~utmtion) AHOUNT PAID * ~-/. o, PART DATE PAID PAYEE Under P~nmltims of per.~ury, I declare that the fmct$ 1' harm reported ~bove arm trum~ correct and c°mpI~:~tL °f 'Y kn°wledg' 'nd bali'' ' HOPJE ¢ ?/7 ) ~_~7~ TAXPAYER STSNA~'UR TELEPHONE NUHBER COHMONk~ALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DELLA A COSEY q06 W SZDDONSBURG RD DILLSBURG PA 17019 ZNFORMATZON NOTICE AND TAXPAYER RESPONSE FZLE NO. 21 - ACN 0qlql$91 DATE 10-Z0-200q TYPE OF ACCOUNT EST; OF ;RUTH C HARROLD [] SAYZ~S S.S. NO. Z10-$2-7519 [] CHECKZNS DATE OF DEATH 07-10-Z00q* [] TRUST CUMBERLAND [] CERTZF. REMZT PAYMENT AND FORMS TO: RESTSTER OF WTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the in~ormation listed be/aw whloh has been used In COMPLETE PART I BELOW x # # SEE REVERSE SIDE FOR FILING AND PAYMENT ZNSTRUCTZONS Account No. lq8777-11 Oa~e 12-22-1999 Established Accoun~ Balance ~,05S.0~ Percen~ Taxable X 50.000 Amount Sub~ect to Tax 529.01 Tax R~te X .Oq5 Potential Tax Due Z3.S~ PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your PART ] relat/onship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS /~ 0~5"-.~,- O/ ,/I-~9. ~ / - o/ LINE l. Date Established 2. Account Balance 3. Percent Taxable q. Amount Sub~ect to Tax E. Debts ~nd Deductions 6, Amount Taxable 7. Tax Rate B. Tax Due PART DEBTS AND DEOUCTZONS CLAZMED ~ ~-I"~,~,00 DATE PAID PAYEE DE$CRIPTIOH 5.1~cc'~n~ ~,--x~. I ,~'_"]<?. o/ TOTAL (Enter on Line S of Tax Computation) (4~ndar penalties of perjury, [ declare that the facts T have reported above are true, correct and coeP~, (~st of~y~K~ry knowl,dg, ,nd bali,f. HOME , ~e~ WORK ( ) TAXPAYER SIGNATURE L ~ TELEPHONE NUMBER DATE GENERAL ~NFORNAT~ON 1. FAZLURE TO RESPOND #~LL RESULT ZN AN OFFZCZAL TAX ASSESSNENT .ith appliclbl, interest based an infarmatJon REPORTZNG INSTRUCTIONS - PART I - TAXPAYER RESPONSE TAX RETURN - PART 2 - TAX CONPUTATION CLATHED DEDUCTTONS - PART $ DEBTS AND DEDUCTIONS CLAIMED COMMONWEALTH OF PE~qSYLVANZA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXED DEPT. 2D0601 DELLA A COSEY q06 H SZDDONSBURG RD DILLSBURG PA 17019 ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE ~ZLE NO. 2z ACN DATE 10-20-200q TYPE OF ACCOUNT EST. OF RUTH C HARBOLD []SAVZNS$ S.S. NO. Z10-S2-7S19 [CHECKZNg DATE OF DEATH 07-10-200q []TRUST COUNTY CUMBERLAND []CERTZF. i~ ;~6 REMIT PAYMENT AND FORMS TO: RESISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MENBERS 1ST FCU has provided the Department with the information listed beZow ~hJch has been used COMPLETE PART 1 EELON # # # SEE REVERSE SIDE FOR FILZNG AND PAYMENT INSTRUCTIONS Account No. lq8777-00 Date 12-22-1999 Established Account Balance 1,7Z0.8! Percent Taxable X 50.000 Amount Subject to Tax Tax Rate X .Oq5 Potential Tax Due $8.72 PART TAXPAYER RESPONSE CHECK ~ Rills and an official assessment will be issued b~ the PA Department of Revenue. ONE ¥~ must complete PART ~ and/or PART ~ below. PART [f you fLndtcate a different tax rate, please state your TAX RETURN -COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS LZNE 1. Date Established 2. Account Balance 3. Percent Taxable q. Amount Subject to Tax ~. Debts end Duductions 6. Amount Taxable 7. Tax Rat~ 8. T~x Due PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tax Computation) $ A:""'/~.(~), g// Under permltles of perjury, ! dec,.are that the facts Z have reported above are true) correct end c°mpl~(~/~l: °f mY kn°wladga and beli'f ' HOME (7/'7) TAXPAYER STGNA_UR~" TELEPHONE NUMBER DATE GENERAL INFORHATZON 1. FAZLURE TO RESPOND W/LL RESULT ZN AN OFFZCZAL TAX ASSESSHENT .ithappllgable interest based on information REPORTING INSTRUCTIOHS - PART I - TAXPAYER RESPONSE TAX RETURN - PART Z - TAX CONPUTAT'rON CLAI'MED DEDUCTTONS - PART :~ DEBTS AND DEDUCTTONS CLATMED COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVI~(t4XE$: INHERITANCE TAX bIYISroiC:" '... ,-, PO BOX Z80601": - ' , HARRISBURG PA 171Z8-0601' NOTICE OF INHERITANCE TAX APPRAISEKENT ALLOHANCE OR DISALLOHANCE OF DEDUCTION~. AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1S41 EX AFP 112-04> 7f\ilt; ",-.vl.)-4.} 11:44 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-21-2005 HARBOLD 07-10-2004 21 04-1035 CUMBERLAND 210-32-7319 04141391 Allount Rellitted RUTH C ORPl.~ti~S;,~iS (~C)t.JRT DEL LA CUi\h"3:qO~~~n 406 W SIDDONS BURG RD DILLSBURG PA 17019 MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 TO: . CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=is4-i-i3f-AFii-foi-:03i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-21-2005 ESTATE OF HARBOLD RUTH C DATE OF DEATH 07-10-2004 COUNTY CUMBERLAND FILE NO. 21 04-1035 TAX RETURN WAS: S.S/D.C. NO. 210-32-7319 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04141391 FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 148777-11 TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 12-22-1999 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 1.058.01 0.500 529.01 529.01 .00 .45 .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 ABOVE ADDRESS. 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 . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" ( CR). YOU HAY BE DUE A REFUND. ~~~ .."',,"'.."'''' "'Tne ne TIITe:. I:'ORM I:'OR YNSTRUCTIONS. ) <:::::l-S~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISE"ENT~ ALLOKANCE OR DISALLOKANCE OF DEDUCTION~, AND ASSESS"ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 EX AFP (12-04) DELLA A COSEY 406 W SIDDONSBURG RD DILLSBURG PA 17019 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 04-04-2005 HARBOLD 07-10-2004 21 04-1035 CUMBERLAND 210-32-7319 04141392 Allount Rellitted RUTH C 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 ~ RE-Y=is4-i-EX--AFP--foi-:03i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-04-2005 ESTATE OF HARBOLD RUTH C DATE OF DEATH 07-10-2004 COUNTY CUMBERLAND FILE NO. 21 04-1035 TAX RETURN WAS: S.S/D.C. NO. 210-32-7319 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION c(J ACN'j :'~:4141392:l, - ;'"./.1 .""".;,:_~ FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 14871i~()'o ..:.:\ TYPE OF ACCOUNT: DATE ESTABLISHED (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE 12-22-1999 (..) -J x 1,720.81 0.500 860.41 860.41 .00 .45 .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 ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 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 . 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" ( CRl, YOU MAY BE DUE A REFUND. ~~~ R~U~RS~ SYD~ OF THYS FORM FOR INSTRUCTIONS. l S\L Q