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' DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-13)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 05-12-2014
ESTATE OF RICHWINE FRANCIS K
DATE OF DEATH 08-07-2013
FILE NUMBER 21 13-0885
COUNTY CUMBERLAND
RICHWINE GEORGE M ACN 101
2224 W 17TH ST Amounk Remitted
WILMINGTON DE 19806-2424
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 4-
REV-1607 EX AFP C12-13) **■ INHERITANCE TAX STATEMENT OF ACCOUNT ■;■
ESTATE OF:RICHWINE FRANCIS K FILE NO. : 21 13-0885 ACN: 101 DATE: 05-12-2014
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: 04-14-2014
PRINCIPAL TAX DUE: 158,494e¢�6
N
O_
PAYMENTS (TAX CREDITS) : n s m
C rn C)
710 ZB G-� CD
PAYMENT RECEIPT DISCOUNT (+) m {
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID M :T_ o
p 1- fV (71 CT7
11-04-2013 CDO18364 7,902.79 150,153.09 r 4 C - o
04-26-2014 CDO19075 '.00 438.78
p n C7
OO -+l �-- � n
N M
r
a r, Cn o
n w T
TOTAL TAX PAYMENT 158,494.66
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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