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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX
REV-1607 IX AFP (12-13)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO BOX
HARRISBURG URG PA PA 17128-0601
DATE 03-10-2014
ESTATE OF FULLERTON WENDY L
DATE OF DEATH 01-30-2013
FILE NUMBER 21 13-0208
F COUNTY CUMBERLAND
ULLERTON ADAM p
ACN 101
APT 9
5312 OXFORD CIR Amount Remittetl
MECHANICSBURG PA 17055-4421
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 --► RETAIN LOWER PORTION FOR YOUR RECORDS !--
REV-1607 EX AFP C12-13) ■;; INHERITANCE TAX STATEMENT OF ACCOUNT ■;*
ESTATE OF:FULLERTON WENDY L FILE NO. : 21 13-0208 ACN: 101 DATE: 03-10-2014
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: 11-01-2013
PRINCIPAL TAX DUE: 2,644.13
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
ra
05-01-2013 CDO17529 .00 2,464.13
02-18-2014 CDO18779 1.59- 181 .59 O y m C7
02-28-2014 SBADJUST ,00 , 05 C' �'{
- G�
:11 C) tT
T;7 0
w
TOTAL TAX PAYMENT 2,644. 13
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.