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BUREAU OF INDIVIDUAL TAXES REGISTER ~~~~-~,ANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISIDN REV-1607 EX AFP C12-11)
Po Box zso6ol ~, STATEMENT OF ACCOUNT
HARRISBURG PA 17126-0601 ~~~~ IL'U~ ~O ~f~ ~.',L L~~
CLGf~I( 0~ DATE 11-26-2012
ESTATE OF REISMAN BURTON
t3RPHANS' COURT DATE OF DEATH 05-01-2012
GBERLAND CO., t~~ FILE NUMBER 21 12-0548
COUNTY CUMBERLAND
KEITH O BRENNEMAN ACN 101
44 W MAIN ST
Amount Remitted
MECHANICSBURG PA 17055-6249
MAKE CHECK PAYABLE 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-1607 EX AFP (12-11) *** INHERITANCE TAX STATEMENT OF ACCOUNT ~**
ESTATE OF:REISMAN BURTON FILE NO.: 21 12-0548 ACN: 101 DATE: 11-26-2012
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: 10-22-2012
PRINCIPAL TAX DUE: 9,950.79
PAYMENTS CTAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-26-2012 CD016305 496.16 9,427.08
11-13-2012 CD016766 .00 27.55
TOTAL TAX PAYMENT 9,950.79
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" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.