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DEPARTMENT OF REVENUE
INHERITANCE BUREAU OF VI TAXES INHERITANCE TAX REV-1607 EX AFP (12.12)
PO BOX AX DIVISION 1VI SION SIGN STATEMENT OF ACCOUNT
HARRISBURG PA 17128-0601
RECORDED OFFICE OF
REGISTER OF WILLS DATE 12-09-2013
ESTATE OF DEVORICK SR JOHN T
1013 IJ(.� i 1 �� 7 yC DATE OF DEATH 07-30-2013
lr GJ FILE NUMBER 21 13-0880
JERK OF COUNTY CUMBERLAND
JOHN T DEVORI ACN 13168239
44 SUMMER DR ORPHANS' CO55U�(R� T Amawnt Remitted
DILLSBURG CUM9ER1L'Rhb74V.4PA
Li tiLFflll 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 4 -
REV-1607 EX AFP C12-12) ■;* INHERITANCE TAX STATEMENT OF ACCOUNT ■;;
ESTATE OF:DEVORICK SR JOHN T FILE NO. : 21 13-0880 ACN: 13168239 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: 12-06-2013
PRINCIPAL TAX DUE: 2.34
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-06-2013 SBADJUST .DO 2.34
i
TOTAL TAX PAYMENT 2.34
BALANCE OF TAX DUE .00
INTEREST AND PEN. X00
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. /'-/�