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BUREAU OF INDIVIDUAL TAXE'S I^ ~~'~INHERITANCE TAX
INHERITANCE TAX DIVISION S T A T E M E N T O F A C C O U N T
PO BOX 280601
HARRISBURG PA 17128-0601
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JUSTIN C JUMPER
13 WEST SPRINGVILLE RD
BOILING SPRINGS PA 17007
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DEPARTMENT OF REVENUE
REV-1607 EX AFP C12-1[I)
DATE 01-10-2011
ESTATE OF JUMPER CURTIS A
DATE OF DEATH 09-22-2010
FILE NUMBER 21 10-1041
COUNTY CUMBERLAND
ACN 10163783
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
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 AFPr C12 10~~~~ ~~ *~* INHERITANCE TAX STATEMENT~OF~ACCOUNT s***~~w~~r~~N~~~~~~~r~~u~~~
ESTATE OF:JUMPER CURTIS A FILE NO.: 2i 10-1041 ACN: 10163783 DATE: 01-10-2011:
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMAF;Y OF= THE: PRINC][PAI_
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED IN'fI=REST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-03-2011
PRINCIPAL TAX DUE:
72.48
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-05-2010 CD013751 3.62 68.86
TOTAL TAX PAYMENT I 72.48
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE I .00
* IF PAID AFTER THI`.> DATE, SEE REVERSE SIDE 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.
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