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DEPARTMENT OF REVENUE
BUREAU OF INDIVI �, s� t 1C �� INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX RJEV N �_�TAx� STATEMENT OF ACCOUNT
PO BOX 280601 —n C
HARRISBURG PA 171Wl_jG3dj,) _i 4 , , J
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LQ DATE 02-23-2015
J 11 � I ESTATE OF HUSSON MARY M
DATE OF DEATH 12-10-2013
C�-E FILE NUMBER 21 13-1324
COUNTY CUMBERLAND
SHEEV ES,Q,-m : , -ANDREW 'C ACN 101
127 S WAR'K�T -ST
Amount Remitted
PO BOX 95
MECHANICSBURG PA 17055-0095
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 X;;
ESTATE OF:HUSSON MARY M FILE NO. : 21 13-1324 ACN: 101 DATE: 02-23-2015
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: 01-26-2015
PRINCIPAL TAX DUE: 4,947.28
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-07-2014 CDO18861 247.36 5,000.00
02-09-2015 REFUND .00 300.08-
TOTAL TAX PAYMENT 4,947.28
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. ��\