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' DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUA �TpCX1 It1 INHERITANCE TAX
INHERITANCE TAX DIVISIO REV-1607 EX AFP (12 14)
PO BOX 280601 ((�'� QQHA.;` ' .r', i STATEMENT OF ACCOUNT
HARRISBURG PA 17120'- ,
C� DATE 05-04-2015
ESTATE OF BERLIN ANDREW
DATE OF DEATH 05-02-2014
FILE NUMBER 70 0503781
COUNTY CUMBERLAND
NELSON D BERLIN ACN 14132949
903 CEDAR RD
MECHANICSBURG PA 17050-2602 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
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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REV-1607 EX AFP (12-14) *** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF:BERLIN ANDREW FILE NO. : 70 0503781 ACN: 14132949 DATE: 05-04-2015
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: 05-04-2015
PRINCIPAL TAX DUE: 7.21
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
05-01-2015 WRITEOFF .00 7.26
TOTAL TAX PAYMENT 7.21
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" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.
PAYMENT: Detach the top portion of this notice and submit with your payment to the name and address indicated on the front of the
notice.
If payment is for a resident decedent,make a check or money order payable to:Register of Wills,Agent.
If payment is for a non-resident decedent,make a check or money order payable to:Commonwealth of Pennsylvania.
REFUND(CR): A refund of a tax credit not requested on the tax return may be requested by completing an Application for Refund of
Pennsylvania Inheritance and Estate Tax(REV-1313). Applications are available at www.revenue.pa.gov or by
calling 1-800-362-2050. Services for taxpayers with special hearing and/or speaking needs are available at
1-800-447-3020. Please allow four to six weeks from the date a refund was granted to receive the check.
ADMINISTRATIVE Errors discovered on this assessment should be addressed in writing to:
CORRECTIONS: PA Department of Revenue
Bureau of Individual Taxes
Post Assessment Review Unit
PO BOX 280601
Harrisburg PA 17128-0601
See instructions for Inheritance Tax Return for a Resident Decedent for details on an administrative correction.
DISCOUNT: If any tax due is paid within three months after the decedent's death,a 5 percent discount of the tax paid is allowable.
INTEREST: Interest is charged beginning nine months and one day from date of death,to the date of payment. An interest calculator is
available at www.doreservices.state.pa.us. Annual interest rates can be found on form REV-1611.
Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment.
If payment is made after the interest calculation date shown on the notice,additional interest must be calculated.