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INHERITANCE TAX DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION
PO BOX 280601 STATEMENT OF ACCOUNT
HARRISBURG PA 17BEftQRDED OFFICE OF
REGISTER OF WILLS DATE 07-13-2015
ESTATE OF GARBACIK RAYMOND R
?015 JUL 20 PM 12 40 DATE OF DEATH 02-08-2013
FILE NUMBER 21 13-0194
CLERK OF COUNTY CUMBERLAND
RICHAR10 R p 8 AqffB A
221 ACN 14101755
Amount Remitted
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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 --0- RETAIN LOWER PORTION FOR YOUR RECORDS -- --- -- - --- -----
-f -ififE;Etif O� ACCOUNT
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ESTATE OF:GARBACIK RAYMOND R FILE NO. : 21 13-0194 ACN: 14101755 DATE: 07-13-2015
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: 03-13-2015
PRINCIPAL TAX DUE: 2,943.56
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
05-08-2013 CDO17584 147. 18 2,796.83
12-23-2014 CD020068 .00 24.99
04-14-2015 CD020527 .00 291 .64
06-24-2015 REFUND .00 317.08-
TOTAL TAX PAYMENT 2,943.56
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.