2007 PFC Letter for Electronic Filers

02/17/2008

Dear Taxpayer: 349-82-2391

Your electronically filed 2007 Indiana Individual Income Tax Return indicates a
balance owed to the Indiana Department of Revenue in the amount of $ 99.00 .
If you have any questions regarding this amount owed, you should consult the
tax preparer who prepared your income tax return electronically. Avoid penalty
and interest charges by making your payment before the April 15,2008, tax due date.
You may pay by mail, by telephone, or via the Internet.

To pay by paper check or money order, mail your payment and the tear-off coupon at
the bottom of this letter to: Indiana Department of Revenue, PO Box 1674,
Indianapolis, IN 46206-1674. Make your check or money order payable to “Indiana
Department of Revenue”. PLEASE DO NOT SEND CASH.

You may also pay by using the Indiana IN-ePay System. You may pay by electronic
Check (eCheck) over the Internet by accessing our webpage at www.in.gov/dor/epay
and follow the instructions. The fee for paying by eCheck is $1.00.

Finally, you may also use the Indiana IN-ePay System to pay by a major credit card
You can access this payment method at the webpage indicated above or by touch
tone telephone at 1-800-2PAYTAX (1-800-272-9829) toll free. You will then be
prompted for the information necessary to make your payment. A convenience fee
will be charged by the credit card processor based on the amount of tax you are
paying. You will be told what the fee is and you will have the option to cancel or
continue the credit card transaction.

Sincerely,
INDIANA DEPARTMENT OF REVENUE

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _Cut on_line before

_ mailing.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PFC

Mail and make check payable to:

Indiana Department of Revenue
P.O. Box 1674
Indianapolis IN 46206-1674
Danielle E Knoblett
356 Mill Springs Amount Due:
fillmore, IN 46128
 DCN 0 0 8
Form Do Not Mail
This Form Indiana Individual Income Tax
IT-8453OL
State Form 46201 DECLARATION OF ELECTRONIC FILING
(R6 / 8-07) For the tax year January 1 - December 31, 2007

First Name(s) and Middle Initial(s) Last Name Your Social Security Number
Danielle E Knoblett 349-82-2391
Spouse's First Name(s) and Middle Initial(s) Last Name Spouse's Social Security Number

Street Address Apartment Number

356 Mill Springs
City State Zip Code Daytime Telephone Number
fillmore IN 46128 (765)246-6050
Part I Tax Return Information (Whole Dollar Amounts Only)
1. Federal Adjusted Gross Income (Form IT-40, Line 1 or IT-40EZ, Line 1) . . . . . 1. 9,854.00
2. Indiana taxable income (Form IT-40, Line 15 or IT-40EZ, Line 5) . . . . . . . . 2. 8,854.00

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DO NOT MAIL
3. Total Indiana tax (Form IT-40, Line 22 or IT-40EZ, Line 9) . . . . . . . . . . . .

4. Total state tax withheld (Form IT-40, Line 23 or IT-40EZ, Box 10) . . . . . . . .

5. Total county tax withheld (Form IT-40, Line 24 or IT-40EZ, Box 11) . . . . . . .
3.

4.

5.
434.00
335.00

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6. Total Indiana tax credits (Form IT-40, Line 31 or IT-40EZ, Line 13) . . . . . . . 6. 335.00
7. Refund (Form IT-40, Line 39 or IT-40EZ, Line 16) . . . . . . . . . . . . . . . . . 7. D
8. Amount you owe (Form IT-40, Line 44 or IT-40EZ, Line 21) . . . . . . . . . . .

Part II Direct Deposit

8. 99.00
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T 9. Routing number Note: The first two digits of the routing number must be 01 - 12 or 21 - 32.
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C 10. Account number Do Not Mail
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11. Type of account: Checking Savings Hoosier Works MC This Form

My request for direct deposit of my refund includes my authorization for the Indiana Department of Revenue to furnish my
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financial institution with my routing number, account number, account type, and social security number to insure my refund is
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properly deposited.
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Part III Declaration of Taxpayer
If I have filed a balance due return, I understand that if the IDOR does not receive full and timely payment of my tax liability, I
will remain liable for the tax liability and all applicable interest and penalties.
Under penalties of perjury, I declare that the amounts in Part I above agree with the amounts on the corresponding lines of the
electronic portion of my 2007 income tax return. To the best of my knowledge and belief, my return is true correct and complete.
I consent to allow my transmitter to send my return, this declaration, and accompanying schedules and statements to the IDOR.
I also consent to the IDOR sending an acknowledgement of receipt of transmission and an indication of whether or not my
return is accepted, and, if rejected, the reason(s) for the rejection.

Please
Sign Here
Taxpayer's Signature Date Spouse's Signature Date
1064