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BUREAU OF INDIVIDUAL TAXES ~ ~, ~.;_' ~, t ',I'~kfRIT
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REV-1607 EX AFP C12-09)
INHERITANCE TAX DIVISION ' ~
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PO sox 280601
HARRISBURG PA 17128-0601
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t DATE 12-06-2010
ESTATE OF ROBBINS MARYLOUSE
~~~~( ~;~ DATE OF DEATH 01-18-2009
d~P~`~~~~'} v~J~,~~T FILE NUMBER 21 09-0071
~~~~,~~'~-~', .~,~tiS` i~~ , PA COUNTY CUMBERLAND
ROBERT G FREY ACN 101
FREY SIB TILEY
Amount Remitted
5 S HANOVER ST
CARLISLE PA 17013
MAKE CHECK PA YABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG_ THIS LINE __~_ RETAIN LOWER PORTION FOR YOUR RECORDS ~ _ _ __ __
REV X1607 EX AFP C12 091 ~ ~ *** INHERITANCE TAX STATEMENT~OF ACCOUNT ~~~** ~~~~ w~~ ~ ~ ~~~~~~
ESTATE OF:ROBBINS MARYLOUSE FILE NO.: 21 09-0071 ACN: 101 DATE: 12-06-2010
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-13-2010
PRINCIPAL TAX DUE:
14,451.98
PAYMENTS CTAX CREDITS):
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID t-)
04-17-2009 CD011124 657.89 12,500.00
12-14-2009 CD012098 .00 317.00
11-08-2010 CD013610 .00 512.50
11-08-2010 CD013609 45.92- 512.50
TOTAL TAX PAYMENT ~ 14,453.97
BALANCE OF TAX DUE 1.99CR
INTEREST AND PEN. .00
TOTAL DUE ,
1.99CR
* IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.