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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-13)
INHERITANCE TAX o1vlsloN
PO BOX 280601 STATEMENT OF ACCOUNT
HARRISBURG PA 17128-0601
DATE 09-08-2014
ESTATE OF ZACK MARIE L
DATE OF DEATH 07-22-2013
FILE NUMBER 21 13-0943
COUNTY CUMBERLAND
WALLET DEBRA K
ACN 101
24 N 32ND ST
CAMP HILL PA 17011-2900 Amount Remitted
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
REV-1607 EX AFP C12-13) *xx INHERITANCE TAX STATEMENT OF ACCOUNT x;■
ESTATE OF:ZACK MARIE L FILE NO. : 21 13-0943 ACN: 101 DATE: 09-08-2014
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: 08-25-2014
PRINCIPAL TAX DUE: 15,695. 12
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID n o
rn
10-07-2013 CDO18212 784.76 15,000. 031; C:> J) h
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08-25-2014 REFUND .00 89. -� -"no cn ::a
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TOTAL TAX PAYMENT 15,695. 12
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.