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i DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO Box OFFICE OF
HARRISB 712B�0601
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REGI ST7 *�'I r— DATE 02-17-2015
qB 23 PF� 12 (2-9 ESTATE OF FRANTZ HAROLD
DATE OF DEATH 12-21-2013
PILE NUMBER 21 14-0170
COUNTY CUMBERLAND
PMR�T!TiE` (FAAN, IZ ACN 14105296
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� I Amount Remitted
UMBERLAND PA 17070-2203
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:FRANTZ HAROLD FILE NO. : 21 14-0170 ACN: 14105296 DATE: 02-17-2015
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: 335.42
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
01-17-2015 CD020195 2.94- 338.36
02-13-2015 SBADJUST .00 .31
TOTAL TAX PAYMENT 335.42
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.