HomeMy WebLinkAbout06-17-15 pennsyLvania
DEPARTMENT OF REVENUE
B �X INHERITANCE TAX REV-1607 EX AFP (12-14)
I U=t �dV PIdN STATEMENT OF ACCOUNT
N 440CH 71M
PO BFHARR SURD PA 17128-'0601
?51S 93 DATE 06-08-2015
LiU 11 ESTATE OF DOMENE III RALPH R
L E R OF DATE OF DEATH 05-26-2014
ORPHAN S' COURT FILE NUMBER 21 14-0627
COUNTY CUMBERLAND
C U
TAM` (DOTMbMPSON ACN 14140496
412 N 21ST ST
Amount Remitted
CAMP HILL PA 17011-2201
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
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----- I _ _ 4X T1 OF ACCOUNT **
AFP (12-14)(12-14) f WHHEAH f
iii-ll�if 6X
ESTATE OF:DOMENE III RALPH R FILE NO. : 21 14-0627 ACN: 14140496 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: 06-08-2015
PRINCIPAL TAX DUE: 4.26
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
06-05-2015 SBADJUST .00 4.29
TOTAL TAX PAYMENT 4.26
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.