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F HER I TANCE TAX DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXER REV-1607 EX AFP (12-11)
INHERITANCE TAX DIVISION E M E N T OF ACCOUNT
PO BOX 280601 ~l~l t r i,, .f
HARRISBURG PA 17128-0601
DATE 08-06
c AUG 13 PM 12. 23 ESTATE OF ICKES-2012 JUNE W
DATE OF DEATH 01-15-2011
FILE NUMBER 21 11-0533
offilk COUNTY CUMBERLAND
GEORGE F DOUQAf~ E~.Af X80, PA ACN 101
354 ALEXANDER SPRING RD
Amount Remitted
CARLISLE PA 17015-7451
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
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REV--1607 EX AFP C12-11) INHERITANCE TAX STATE-MENT OF ACCOUNT*
ESTATE OF:ICKES JUNE W FILE NO.: 21 11-0533 ACN: 101 DATE: 08-06-2012
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: 07-09-2012
PRINCIPAL TAX DUE: 4,896.11
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
03-21-2012 CDO15731 .00 4,896.11
07-24-2012 CDO16293 63.43- 63.43
TOTAL TAX PAYMENT 4,896.11
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
.00
IF PAID AFTER THIS 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. 1~t