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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 STATEMENT OF ACCOUNT
HARRISBURG PA REE(C)6V D E DD 0 F F71 C LE 0 F
R E G I S T',-�Hl W 1 Ll 1-S DATE 09-08-2015
ESTATE OF ADRIAN BETTY i
?01S SEP 19 F-.,M I 13 2 DATE OF DEATH 12-03-2014
FILE NUMBER 21 14-1223
C L E R C COUNTY CUMBERLAND
NOEL2flF�F,��i,,,,, ,JAMES- K ACN 101
STE Amount Remitted
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570CPA�& N'-
LANCASTER PA 17601-3076
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I 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 --- -- -- -
- --- - ----
I
- O� ACCOUNT REV-1607 -ex THIS
17P" C12-14)- - -- -*;; -fij*HNffA7NH f A -gffiYE;&W 7k
ESTATE OF:ADRIAN BETTY J FILE NO. : 21 14-1223 ACN: 101 DATE: 09-08-2015,
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: 08-10-2015
PRINCIPAL TAX DUE: 8,694.00_
PAYMENTS CTAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
02-24-2015 CD020288 434.70 8,336.25
08-24-2015 REFUND . 00 76.95-
TOTAL TAX PAYMENT 8,694.00
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.