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���J1 OEPARTMENT OF pEVENUE
BUREAU OF INDIVIDUAL raxes . ,. INHERITANCE TAX � REV-1607 E7( AFP U2•ID
INNERITANCE TA% DIVISION STATEMENT OF ACCOUNT
PO BO% 280b01
NABRISBORG PA ���ze-oso� RECORDED OFFICE OF��
REGISTER OF l�il.LS narE o�-oa-ZOia
m ESTATE OF RIVERA MENA
���� ��� 12 PII 2 2`L DATE OF DEA7H 07-25-2012
. FILE NUMBER 21 12-1024
HATCH ESp CRA1`G"ER'A�F � COUNTY CUMBERLAN�
1013 MUMMA RD ORPHANS� COURT ACN 101 ,
LEMOYNE_ CUM�€RL�AIA�i}t�.4 PA Amount Rem3tice -
MAKE CNECK PAYABLE AND REMIT PAYMENT TU:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17�13
NOTE: To ensure Orope� cr¢ESt to your account, submit the uppor port3on of this form with your tax payment.
CUT ALON6 THIS LINE �-�► RETAIN LOWER PORTION FUR YOUR RECORDS !�-�
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REV-1607 EX AFP (12-12J ■�� INHERITANCE TAX STATEMENT OF ACCOUNT xrx
ESTATE OF:RIVERA MENA FILE NO. : 21 12-1024 ACN: 1�1 DATE: 07-08-2013
THIS STATEMENT PROVIDES CURRENT STATUS OF TNE STATED ACN IN THE NAMED ESTPTE. BELOW 1S A SUMMARY OF TNE PRINCIPAI
TAX OUE, APPLICATION OF ALL PAVMENTS, THE CURRENT BALANCE,'ANO. IF APPIICABLE, A PROJECTED INTEREST FIGURE.
DA7E OF LAST• ASSESSMENT OR RELORD ADJUSTMENT: U6-17-2U13
PRINCIPAL TAX DUE: 11 ,013.61
PAYMENTS CTAX CREDITS> :
PAYMENT RECEIPT DISCOUN7 <+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)'
10-22-2012 CD016677 526.32 10,000.00
11-21-2012 C0016828 .00 236. 10
U4-23-2013 CD017492 .00 251 . 19
TOTAL TAX PAYMENT 11,013.61
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
.00
x IF PAID AFTER THIS DATE� SEE REVERSE SIDE FOR CAICULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), VOU MAV BE OUE A REFUND. SEE REVERSE SIDE OF THSS fORM ,\
FOR� INSiRULTIONS. \�v�
PAVMENT: OeYach khe top Dort3on of this nofice and submiY w3th vou� oaYment maAe paYable ko ihe name and atldress
printed on the reverse side.
If Devment is for a �esitleni decedenf, make check or moneY oreer oaYable fo: Regist¢r oF Wills. A9enk
If Davmeni is for a non-resident decedent. make check or moneY order vavable ko: Lommonvealth oF Pennsvlvania
Failure to pay Yhe Sax, inkerest, and penalty due maY result in Yhe tiling ot a lien of record in the
appropriafe countY, or the issuance of an O�ohan's Court citaYion.
REFUND (CR): A refuntl of a tax c�edif, which was not reuuested on Yhe tax �eturn� may be requesYetl bY comOletin8 an
"AOOlicakion for Refuntl of PennsYlvan3a Inhe�itance antl Estate Tax" (REY-1313]. ApOlicakions are available from
tlepartmenY's Web site ai vw.revenue.state.oa.as, anv Regisker of Wills or Revenue OisYr3ct Office or from the
tle0artment's 24-hour answerin9 service: 1-800-362-2050; services for taxoaYers with sVecial hearin9 and/or
soeaking needs: 1-800-44]-3020 (TT on1Y).
REPLY T0: Queskions re9arding errors shoultl be atltlressed to: PA OeoarYmenk of Revenue, eureau of Individual Taxes,
ATiN: Post Assessment Review Unit, PO Box 280601. Harrisburg� PA 17128-0601, or call (717) 781-6505.
OISCOUNT: If aro taz tlue is pa3d viYhin three calendar monkhs after Yhe decedent's Aeakh. a five Derce�t discount
of the k� paitl is allmretl.
PENALTY: The 15 percent taz amnestv nomDarticioation oenalty is comoufed on the total of khe tax and inferest assessed�
and not paid before Jan, lBa 1996, (k�e first tlaY afier the end of the tu amnesty oeriodJ
INTEREST: Interest is char9etl beginning aith first tlaY of delinauencY, or n5ne months and one day from the tlate of
deakh, ko the tlate of Pavmenk. Taxes vhich became delinauent before Jan. 1, 1982, bear interest at the rate of '
six nercent Der annum calculatetl ak a tlailv rake of 0.000164. All tazes which became tlel3ntluent on and after
Jan. 1, 1982. will trear interest ak a rate ahich varies from year to vcar with the rete announced bv Yhe PA
Deoartment of Revenue. f2aYes for 1962 through 1999 can be found in khe PennsYlvania Resitlenk Instru<tion
Booklek CREV-1501)� k�e PennsYlvan3a Noo-resitlent Instruckion Booklet BEV-1136) or en the OeOartmenk of
Revenue Web site ww.revenue.state.oa.us. The apolicable interesY rates fo� Z000 t�raugh 2033 are:
InYereSY Oaily lnterasY Oaily Interest Daily
Year RaYe Fackor Vear Rate Factor Vear Rake FacYO�
2000 BY. .000219 2001 9% .D0024'! 2002 6'/. .000164
2003 5Y. .00013] 2004 4% .D00110 2005 SY. .00033�
2006 TG .000192 200] BY. .000219 2008 �Y. .000192
2009 5Y. .000137 2010 4Y. .000110 2011-2013 3Y. .000082
InteresY is calculaYed as follows:
INTEftEST = OALANCE OF TAX UNPAID X NUMBER OF DAYS OELINQIIENT X UAILY INTEREST FACTDR
AnY notice issued afTer tbe Yaz becomes tlelinquenk will reflect an interest calculation Yo 15 Eays
bevond the tlaYe of the assessment. If oayment is made after the interest computat3on date shown on the
notice, add3fional 3nteresi must be calculated.
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