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1� , DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION
PO BOX 280601 STATEMENT OF ACCOUNT
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R E G 1 11 "_R C` V1 L L S DATE 05-26-2015
ESTATE OF SHEAFFER GAYLE K
DATE OF DEATH 05-06-2013
?gIS ultlN 2 Fl,55 1-2 FILE NUMBER 21 13-0587
FLOW&-El" THOMAS E COUNTY CUMBERLAND
10 , ., T ACN 101
rHi: GR, ST - , Amount Remitted
P'A 17013-2922
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 --10 RETAIN LOWER PORTION FOR YOUR RECORDS - -- - - -------- - - -
-
-gfi* OF-ACCOUNT PORTION
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ESTATE OF:SHEAFFER GAYLE K FILE NO. : 21 13-0587 ACN: 101 DATE: 05-26-2015
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: 04-27-2015
PRINCIPAL TAX DUE: 10,002.60
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
01-21-2014 CDO18675 .00 5,000.00
10-31-2014 CDO19866 109.53- 5,962.27
11-07-2014 SBADJUST .00 .48
05-11-2015 REFUND .00 850.62-
TOTAL TAX PAYMENT 10,002.60
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. 14
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