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Home My WebLink About12-02-05 (2) BUREAU OF INDIVIDU~~f~~~$'::T) INHERITANCE TAX DIVISION ;- '- ",. - ~ PO BOX 280601 ' HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . . rC INHERITANCE TAX )1 RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS REV-1604 EX AFP (03-05) r .-. ,,", ,C"> ~.,~ ~j - L f'"-.' ,,~ r-) I I. r II c.: ,~'t DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 11-23-2005 HESS 04-29-2005 21 05-0686 CUMBERLAND 195-20-6762 05133668 GINOR H (". !' (-'-'"-' MARY AVERY 6725 OLD BERWICK RD BLOOMSBURG PA 17815 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 11-23-2005 ESTATE OF HESS GINOR H DATE OF DEATH 04-29-2005 COUNTY CUMBERLAND FILE NO. 21 05-0686 ADJUSTMENT BASED ON: S.S/D.C. NO. 195-20-6762 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: COLUMBIA CNTY FARMERS NATL BK ACCOUNT NO. 2202418618 ACN 05133668 TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 10-20-2000 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.083 .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 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 (-) 08-02-2005 ..... CD005644 .00 9.50 10-29-2005 ....... CD005952 .00 .50 TOTAL TAX CREDIT 10.00 BALANCE OF TAX DUE 10.00CR INTEREST AND PEN. .00 TOTAL DUE IO.ooeR · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. Q1- ( 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.) BUREAU OF INDIVIDUAIQ,Til(m'"',!:r,; INHERITANCE TAX OIYISION'--J',,;, ,"_C/ PO BOX Z80601 -- '-,- HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 1 1 rlC INHERITANCE TAX \,1 RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS REY-1604 EX AFP (03-05) r::: -:2 hi 2: L; 4 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSNI'DC ACN 11-23-2005 HESS 04-29-2005 21 05-0686 CUMBERLAND 195-20-6762 05133671 Allount Rellitted GINOR H MARY (,A' AVERY 6725 OLD BERWICK RD BLOOMSBURG PA 17815 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 4- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ REV-1604 EX AFP (03-05) -- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 11-23-2005 ESTATE OF HESS GINOR H DATE OF DEATH 04-29-2005 COUNTY CUMBERLAND FILE NO. 21 05-0686 ADJUSTMENT BASED ON: S.S/D.C. NO. 195-20-6762 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 05133671 FINANCIAL I NSTI TUT I ON: COLUMBIA CNTY FARMERS NATl BK ACCOUNT NO. 4000078406 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 10-01-2002 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.083 .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 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 (-) 08-02-2005 .... CD005644 .00 93.69 10-29-2005 ..... CD005952 .00 4.93 TOTAL TAX CREDIT 98.62 BALANCE OF TAX DUE 98.62CR INTEREST AND PEN. .00 TOTAL DUE 98.62CR · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. pt ( 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. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) BUREAU OF INDIVIDUAL- (f,~ i\ INHERITANCE TAX DIVISIIfIC'", I,,,, 1.-"" ,-' PO BOX 280601 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) 'In"'; /~ l: ., "'"' r.. r-,_~ - (~ fil . ':.4 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSNI'DC ACN 11-23-2005 HESS 04-29-2005 21 05-0686 CUMBERLAND 195-20-6762 05133676 Amount Remitted GINOR H ,"'" '-'-,~ MARY ~ AVERY 6725 OL~BERWICK RD BLOOMSBURG PA 17815 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 11-23-2005 ESTATE OF HESS GINOR H DATE OF DEATH 04-29-2005 COUNTY CUMBERLAND FILE NO. 21 05-0686 ADJUSTMENT BASED ON: S.S/D.C. NO. 195-20-6762 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: COLUMBIA CNTY FARMERS NAlL BK ACCOUNT NO. 5000009228 ACN 05133676 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 02-26-1998 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.083 .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 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 (-) 08-02-2005 ..... CD005644 .00 17.46 10-29-2005 .'..... CD005952 .00 .94 TOTAL TAX CREDIT 18.40 BALANCE OF TAX DUE 18.40CR INTEREST AND PEN. .00 TOTAL DUE 18,40CR · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AJI ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, I<./" YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.J BUREAU OF INDIVIDUAu:::.r~~crj INHERITANCE TAX DIVISION; ;.-\.",>1 !,.'.J PO BOX 28060 1 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) I' " -,:~ 1"").. , 4 ' . 1_1 ~ ~ ,. I DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 11-23-2005 HESS 04-29-2005 21 05-0686 CUMBERLAND 195-20-6762 05133679 GINOR H MARY "AVERY 6725 OLD BERWICK RD BLOOMSBURG PA 17815 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-l&04 EX AFP (03-05) -- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 11-23-2005 ESTATE OF HESS GINOR H DATE OF DEATH 04-29-2005 COUNTY CUMBERLAND FILE NO. 21 05-0686 ADJUSTMENT BASED ON: S.S/D.C. NO. 195-20-6762 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 05133679 FINANCIAL INSTITUTION: COLUMBIA CNTY FARMERS NATL BKACCOUNT NO. 5000009231 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 11-10-2000 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.083 .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 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 (-) 08-02-2005 " CD005644 .00 103.54 TOTAL TAX CREDIT 103.54 BALANCE OF TAX DUE 103.54CR INTEREST AND PEN. .00 TOTAL DUE In::l:.'>4rp · 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" fCR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) Rt BUREAU OF INDIVIDU4J,C/JiAKeS'T\ INHERITANCE TAX DIVISION'_,i",_,,)n',_ ~ '...! PO BOX 280601 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) ~ I' - ~? . ': 4- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 11-23-2005 HESS 04-29-2005 21 05-0686 CUMBERLAND 195-20-6762 05133682 Anount Renitted GINOR H (" MARY 'R AVERY 6725 OLD BERWICK RD BLOOMSBURG PA 17815 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 11-23-2005 ESTATE OF HESS GINOR H DATE OF DEATH 04-29-2005 COUNTY CUMBERLAND FILE NO. 21 05-0686 ADJUSTMENT BASED ON: S.S/D.C. NO. 195-20-6762 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 05133682 FINANCIAL INST I TUTION: COLUMBIA CNTY FARMERS NATL BK ACCOUNT NO. 5000075782 TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 11-26-2001 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.083 .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 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 (-) 08-02-2005 " CD005644 .00 32.28 10-29-2005 ...... CDo05952 .00 1. 70 TOTAL TAX CREDIT 33.98 BALANCE OF TAX DUE 33.98CR INTEREST AND PEN. .00 TOTAL DUE 33,98CR · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PA YHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), f"l J/ YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 1<1' REV'1470 EX (6-88t '* INHERITANCE TAX EXPLANATION OF CHANGES FILE NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME GINOR HESS REVIEWED BY 2105-0686 05133\668,71,76,79,82 SCHEDULE ITEM NO. EXPLANATION OF CHANGES The above referenced ACN has been reduced to zero, as this account was reported on the probate return. Paqe 1