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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-13)
INHERITANCE TAX DIVISION
PO BOX 280601 STATEMENT OF ACCOUNT
HARRISBURG PA 17128-0601
DATE 08-11-2014
ESTATE OF QUINN WINIFRED K
DATE OF DEATH 05-07-2012
FILE NUMBER 21 13-0892
COUNTY CUMBERLAND
THEODORA QUINN ACN 13132703
1700 MARKET ST
Amount R¢mikted
CAMP HILL PA 17011-4817
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 *a*
ESTATE OF:QUINN WINIFRED K FILE NO. : 21 13-0892 ACN: 13132703 DATE: 08-11-2014
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: 05-19-2014
PRINCIPAL TAX DUE: 76.07
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-29-2014 CDO19492 3.00- 79.07
08-08-2014 SBADJUST .00 .35
CYJ -0 CD
r13 -1
na
C7 _tom
11
-:-7 -=rT
c�C n
DJ
N -rT
TOTAL TAX PAYMENT 76.07
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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