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DEPARTMENT OF REVENUE
BUREAU 0 INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANC� T)A�Ull 0 E 0 F STATEMENT OF ACCOUNT
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HARRISBURG
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ESTATE OF MIXELL KATHRYN E
CLE:1',',i OF DATE OF DEATH 06-28-2013
FILE NUMBER 21 13-0893
ORPHANS' COURT COUNTY CUMBERLAND
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�OGER ACN
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354 ALEXANDER SPRING RD Amount Remitted
CARLISLE PA 17015-7451
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— ------ — — --- -- -
- i, --f ififE;bif U ACCOUNT iii-ll;if l6k-WP*-cli:iV)--- --*;; INHERITANCE TAX IiCC7 b i *;;
ESTATE OF:MIXELL KATHRYN E FILE NO. : 21 13-0895 ACN: 101 DATE: 06-08-2015
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: 03-09-2015
PRINCIPAL TAX DUE: 29,789.32_
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
09-28-2013 CDO18191 1,368.42 26,000.00
11-05-2014 CDO19881 44.07- 2,465.37
TOTAL TAX PAYMENT 29,789.72
BALANCE OF TAX DUE .40CR
INTEREST AND PEN. .00
TOTAL DUE .40CR
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.