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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-13)
INHERITANCE TAX DIVISION
STATEMENTPO BOX 280601 OF ACCOUNT
HARRISBURG PA 17128-0601
DATE 01-05-2015
ESTATE OF LINE HENRY
DATE OF DEATH 02-25-2014
FILE NUMBER 21 14-0349
COUNTY CUMBERLAND
PROCTOR J JAMES L ACN 101
STE 202
Amount Remitted
35 E HIGH ST —
CARLISLE PA 17013-3052
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-
REY-1607 EX AFP {12-133 *** INHERITANCE TAX STATEMENT OF ACCOUNT **
ESTATE OF:LINE HENRY FILE NO. : 21 14-0349 ACN: 101 DATE: 01-05-2015
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: 10-20-2014
PRINCIPAL TAX DUE: 3,902.61
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT {+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
05-23-2014 CDO19206 173.45 3,295.54
10-31-2014 CDO19877 .00 433.62
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TOTAL TAX PAYMENT)
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
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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. ` „\