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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 05-19-2014
ESTATE OF GALLAGHER DORIS J
DATE OF DEATH 02-21-2013
FILE NUMBER 21 13-0306
COUNTY CUMBERLAND
KLINE ROBERT P ACN 101
714 BRIDGE ST
Amount Remittetl
PO BOX 461
NEW CUMBERLAND PA 17070-0461
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
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REV-1607 EX AFP (12-13) ■ ■ INHERITANCE TAX STATEMENT OF ACCOUNT N**
ESTATE OF:GALLAGHER DORIS J FILE NO. : 21 13-0306 ACN: 101 DATE: 05-19-2014
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: 5,270. 04
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-) ��i
N
05-17-2013 CDO17627 263.50 6,000.0X'> o m m
05-01-2014 REFUND . 00 993.46 O 3 G> Oo
M7 C'� V) �
T=y T— N M ITT
A
O O
O q
O O 3 T
O ! M
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TOTAL TAX PAYMENT 5,270.04
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.