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- DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DEPARTMENT
EX AFP VENN)
INHERITANCE TAX DIVISION
PO
HARRISBURG6PA�le�, b' D OICE OF STATEMENT OF ACCOUNT
REG#S T E-k 0 LS
DATE 01-20-2015
X91 N c6 nl19 1 `13 ESTATE OF RHOADS JANET K
DATE OF DEATH 08-15-2013
GL ER.; OF FILE NUMBER 21 13-0920
IRWIN 'I9}-{, ,'S' A40i ib S COUNTY CUMBERLAND
64T ��STA „�. � � tI,
ACN 101
CARLTE'! _ ' f Amount Remitted
OP PA 17013-3220
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 C12-14) * INHERITANCE TAX STATEMENT OF ACCOUNT *
ESTATE OF:RHOADS JANET K FILE NO. : 21 13-0920 ACN: 101 DATE: 01-20-2015
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: 12-22-2014
PRINCIPAL TAX DUE: 5,354.23
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-15-2014 CDO19166 .00 11,542.50
12-30-2014 REFUND .00 6,188.27-
TOTAL TAX PAYMENT 5,354.23
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. \�