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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 06-16-2014
ESTATE OF THOMAS CATHERINE A
DATE OF DEATH 12-03-2010
FILE NUMBER 21 11-0826
COUNTY CUMBERLAND
WALLET DEBRA K ACN 101
24 N 32ND ST
Amount Remitt
CAMP HILL PA 17011-2900 ed
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 0 RETAIN LOWER PORTION FOR YOUR RECORDS 4—
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REY-1607 EX AFP C12-13) xxx INHERITANCE TAX STATEMENT OF ACGOUNT ■�■
ESTATE OF:THOMAS CATHERINE A FILE NO. : 21 11-0826 ACN: 101 DATE: 06-16-2014
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: 09-24-2012
PRINCIPAL TAX DUE: 6,446.44
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTERESTIPEN PAID
C Fri
*** SUMMARY OF ALL 005 PAYMENTS • M 6
06-01-2012 .00 6,400.00 b C=
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t` C�. O
t7 p MD
C-> c> 'rY
O C _ C�>
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INTEREST IS CHARGED THROUGH 07-01-2014 TOTAL TAX PAYMENT 6,400.00
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 46.44
INTEREST AND PEN. 79.76
TOTAL DUE 126.20
IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)s YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.