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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE
yTAX
DIVISIONPO BOX STATEMENT OF ACCOUNT
HARRISBURG
6PA 1718 POFD OFFICE OF
REGISTER OF WILLS DATE 06-29-2015
c p ESTATE OF HEBERLIG MILDRED C
?01J{ UAL 6 f M 3 2 DATE OF DEATH 10-01-2014
FILE NUMBER 21 14-0996
CLEC ti COUNTY CUMBERLAND
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' DEt R_ ACN 101
sMW,8'tRLAND Co,, P),A Amount Remitted
14 N MAIN ST
CHAMBERSBURG PA 17201-1814
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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REV-1607 EX AFP (12-14) *** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF:HEBERLIG MILDRED C FILE NO. : 21 14-0996 ACN: 101 DATE: 06-29-2015
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: 05-11-2-015
PRINCIPAL TAX DUE: 28,148.28
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
11-18-2014 CDO19936 5.04 95.67
12-09-2014 CD020014 1 .51 28.71
12-31-2014 CD020086 1,400.82 26,615.49
06-26-2015 SBADJUST ..011 1.04
TOTAL TAX PAYMENT 28,148.28
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. {
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