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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX
INHERITANCE DIVISION 4
REV-1607 EX AFP 022)
PObox 280601 STATEMENT OF ACCOUNT
HARRISBURG PA 17126-0601 '
RECORDED OFFICE OF DATE 12-09-2013
REGISTER OF WILLS ESTATE OF KERR MARLIN R
DATE OF DEATH 07-21-2012
1013 DEC 13 P1D1' j 24 FILE NUMBER 21 12-0902
COUNTY CUMBERLAND
OSZUSTOWICZ JOHN C ACN 101
104 S HANOVER ST CLERK OF
CARLISLE ORf�h1AWI00s,,�-p Amount Remitted
CUMBERLAND CO., PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I 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 N
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REV--1607 EX- AFP--- -(12-12)--- ■x� INHERITANCE TAX STATEMENT OF ACCOUNT *y■- --_ .- _ _ - _ . - _ __
ESTATE OF:KERR MARLIN R FILE NO. : 21 12-0902 ACN: 101 DATE: 12-09-2013
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: 11-04-2013
PRINCIPAL TAX DUE: 36,672.17
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-18-2012 CDO16660 11833.61 371000.0D
11-20-2013 REFUND .00 2,161 .44-
TOTAL TAX PAYMENT 36,672.17
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.
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