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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-13)
INHERITANCE TAX DIVISION
PO BOX STATEMENT O F ACCOUNT
HARRISBURG PA 17128-
ZCME0 OFFICE
OF
RLCIS7E'; ` 1 I L L S DATE 11-10-2014
{� ESTATE OF SHEAFFER GAYLE K
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2014 NDU 17 I";; ! 1123 DATE OF DEATH 05-06-2013
FILE NUMBER 21 13-0587
CLI-r' OF COUNTY CUMBERLAND
FLOWER - THOMAS= -€
10 W HI
ORPAI—) u. f �; i ACN 101
CARLISLPA 7013-2922 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
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REV-1607 EX AFP C12-13) *** INHERITANCE TAX STATEMENT OF ACCOUNT N**
ESTATE OF:SHEAFFER GAYLE K FILE NO. : 21 13-0587 ACN: 101 DATE: 11-10-2014
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: 08-22-2014
PRINCIPAL TAX DUE: 10,835.00
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
01-21-2014 CDO18675 .00 51000.00
10-31-2014 CDO19866 127.27- 5,962.27
11-07-2014 SBADJUST .00 .48
TOTAL TAX PAYMENT 10,835.00
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. ��O\