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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION.
PO BOX 280601 PECORDED STATEMENT OF ACCOUNT
HARRISBURG PA 17128-06DI OFFICE OF
REGIS T 17 1) (,'j:: WILLS DATE 07-27-2015
ESTAHICKMN
?015 AUG 3 PM 12 09 DATETE OFOF DEATH 12-31-A2012 REBEKAH E
FILE NUMBER 21 13-0078
C L E'r_t'"\' C COUNTY CUMBERLAND
ZULLINGER 0R P H AWGr ACN 101
STE 200
14 N MAIN LW B E RL 1�N C C Amount Remitted
CHAMBERSBURG PA 17201-1814 1
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- - - - ----- - -- - --
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ESTATE OF:HICKMAN REBEKAH E FILE NO. : 21 13-0078 ACN: 101 DATE: 07-27-2015
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: 06-29-2015
PRINCIPAL TAX DUE: 23.93
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
01-19-2013 CDO17079 1.20 22.73
TOTAL TAX PAYMENT 23.93
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.