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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION
PO BOX 280601 STATEMENT OF ACCOUNT
HARRISBURG PA 17128-0601 R EE C C.-` c F 10 E GO F
DATE 03-02-2015
ESTATE OF BALTIMORE JULIAN 0
"015 MR 10 P' ! 29 DATE OF DEATH 06-12-2014
FILE NUMBER 21 14-0590
C LEf nT
COUNTY CUMBERLAND
WEIGLE ESQ JEKR�7PH,"A —
ACN 101
126 E KING ST
Amount Remitted
SHIPPENSBURG PA 'i'-1257-1326
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--
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k�V--liif EXAFPlcli:i74) NH TAX
ESTATE OF:BALTIMORE JULIAN 0 FILE NO. : 21 14-0590 ACN: 101 DATE: 03-02-2015
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: 02-02-2015
PRINCIPAL TAX DUE: 1,374.10_
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
09-09-2014 CDO19653 68.71 1,348.26
09-26-2014 CDO19734 .00 42.87
11-01-2014 CDO19873 .00 40.00
02-17-2015 REFUND .00 125.74-
TOTAL TAX PAYMENT 1,374.10
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.