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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP )
INHERITANCE Tax Dlvlsl0" STATEMENT OF ACCOUNT
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HARRISBURG PA 17128-0601 RECORDEL n, Of FiCE OF
R EG1ai E.R OF V!111 LOS DATE 05-20-2013
7 ESTATE OF PETERS MIRIAM L
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211 1 I�� 2 01 FILE NUMBERTN 21 12-1227
LISA MARIE COYNE CLERK Or COUNTY CUMBERLAND
3901 MARKET ST ORPHANS' F � _ ACN Amount bJ�'�R � Amount Remitted
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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 - -� F
RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (12--12)- *;; INHERITANCE TAX STATEMENT OF ACCOUNT ■
ESTATE OF:PETERS MIRIAM L FILE NO. : 21 12-1227 ACN: 101 DATE: 05-20-2013
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: 04-01-2013
PRINCIPAL TAX DUE: 2,735.09
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-06-2013 CDO17150 136.75 3,000.00
04-30-2013 REFUND .00 401 .66-
.
TOTAL TAX PAYMENT 2,735.09
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.
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