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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-15)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 09-29-2014
ESTATE OF MILLER SR RICHARD B
DATE OF DEATH 10-17-2011
FILE NUMBER 21 11-1203
COUNTY CUMBERLAND
DAVIS ESQ HAMILTON C ACN 101
20 E BURD ST
Amount Remitted
PO BOX 40
SHIPPENSBURG PA 17257-1328
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I 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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ESTATE OF:MILLER SR RICHARD B FILE NO. : 21 11-1203 ACN: 101 DATE: 09-29-2014
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: 07-14-2014
PRINCIPAL TAX DUE: 1,261.21
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
03-11-2013 CDO18882 .00 1,261 .21
09-16-2014 CDO19691 24.51- 24.51 C:n
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TOTAL TAX PAYMENT 1,261.21
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.