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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 06-30-2014
ESTATE OF CORNELL RICHARD W
DATE OF DEATH 07-17-2012
FILE NUMBER 21 12-0912
COUNTY CUMBERLAND
THOMAS ESQ R M ACN 101
101 S MARKET ST Amount Remitted
MECHANICSBURG PA 17055-6328
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTEu 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—
R eV*-1607 EX AFP C12-13) )eX INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF:CORNELL RICHARD W FILE NO. : 21 12-0912 ACN: 101 DATE: 06-30-2014
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: 05-27-2014
PRINCIPAL TAX DUE: 1,033.92
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
01-28-2014 CDO18708 .00 1,033.92
06-11-2014 CDO19293 24.25- 24.25 .,
Cr
V 'TT
TOTAL TAX PAYMENT 1,033.92
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.