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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TA E\`
PO BOX 280601 UTDED OFFICE OF - STATEMENT OF ACCOUNT
HARRISBURG PA 17 6t1
T E R, C,7 Vi I L L S
DATE 05-18-2015
?gls MY 26) IM 12 53 ESTATE OF HOLTZMAN DOROTHY i
DATE OF DEATH 01-02-2013
CLEF,", OF FILE NUMBER 21 13-0261
JOHN 4RPH4MH0`L "-'T COUNTY CUMBERLAND
TZMAN ACN 13110566
644 V UO[!f Amount Remitted
WORMLEYSBURG PA 17043-1002 1
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 ---1 - RETAIN LOWER PORTION FOR YOUR RECORDS 4— ---- -- - - ------
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STATEMENT OF i66OACCOUNTX
ESTATE OF:HOLTZMAN DOROTHY J FILE NO. : 21 13-0261 ACN: 13110566 DATE: 05-18-2015
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: 05-14-2015
PRINCIPAL TAX DUE: 239.93_
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
03-11-2013 CDO17309 12.00 227.93
04-18-2014 SBADJUST . 00 2.42
TOTAL TAX PAYMENT 242.35
BALANCE OF TAX DUE 2.42CR
INTEREST AND PEN. .00
TOTAL DUE 2.42CR
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. 0