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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FilE NO: ;) ,,- ,)/ I) - '( '~
TO: (>A~"1 />' ,l;,..)'<ll \~'-Clvv~ S :;".<
..., II \ I~ '/' ~1,Vo '1
,,'HAt,' ((
! I / o~;;r
DATE
ESTATE
\\\0'/1.'
'--'1_
e<,
FILE NO,
COUNTY
DATE OF DEATH
Appraised Velua of Estate:
Real Estate
$
--
Personal Property
+ 30i57 ;II
Jointly Held PropertylTransfers
+
Total Approved Deductions
$ ?'d-f;0
-3/JLf
/t/-d
~/
Total Gross Estate
Clear Value of Estate
$
C::,/
GO
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$
/ l/-:J. ,b- iJ
Amount Taxable @ 6% Rate
$ IL/"J,(,o
tax due
$
Y. .c:(.
u' -=' '.:::J
Amount Taxable @ '5% Rate
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
$
(,5(",
." * ." * ." ." A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$
+ S
$
= s
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
Assess.dby~ W'-j L,
See Inlorm<ltion on Reverso Side /. "0 . AO,ec.!.!r the com~onw~lt
(~L:1t\1J] t.y!,t\~"
$
;:-l,!
w~~,,~~---- ,.
..---.-------- ------ -- +-- -- -- -- -- -- -- ..-- --- - - - -- ---- - ---- --, -- ---.- ---
..-......--~-- ..----
)tl'r:~4Iun8) ,," 'COMMONWEALTH OF PENt.JSYLVANIA
I NO>I063002' DEPARTMENT OF REVENUE ,
S;:,;U" ' ' OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
Ifu;
~
; RECEIVED ______________________EIGHT &
"
= From..
1
~ idress 307 Widder Drive
..
"
II
=
U File No, 21-80-83
i Date 01 Payment
..~
----- --- "'-"- ---..........--
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iBH
Jant.en
56/100-------------------------- dollors
representing Pennsylvania Inheritance or
Estate lax due from the following estale:
2 'I, Tax on
s,
s
Mec:hanic:abuXlJ.
Pa.
17055
6r;, Tax on
s
s
Dote 01 Deoth 7-3-1979
15'i', Tax on
s
s
County
cwaber1and
s
~
II
1
~ri1 11.
1980
9, Tal( on S
Estate Tax, Act of
Moy 7, 1927
s
Nome of Decedent
MARY JANE J.lNTZEIl1
s
-PAID IN PULL-
TOTAL TAX CREDIT
less five percenlum of tax if
paid within three months after
dote of deoth
Plus interest at the rate of
_%from
10
Rf"~
Remarks:
s
s
I
I
'TI'OO~[Jl[L~@g'TI'l] SEAL TOTAL AMOUNT PAID S
NOTE: This Triplicate Receipt to be relainod for audit purposes, .. ....6 I ^~: ._ --/
Received by ~CV1+V; -R. mt..~^^.9c
NOTE: In ocupling the Ironder mhentance la. an future (nlatos, prior to Ihe death 01 the life 1 iQ,Qot~L D I ?-.
"",' " ",.n. 1., y...., .. ";d.n,,d by Ih.. I.'''p'. ,I " und",...d Ihot Ih. C.mm.nwu."h ,h,II Haro "IS. I'l ane, epu y
nol ba precluded or pre~CI"led from hereah'H osuuing addilional, inherilance 10. 01 the deat" of the ReCTist.er of Will.
Iii. lenant or lenont lor yean whene~er il oppears lhat such additional la. may be legally due and (Titlel
collectible lor any rClason .....hatsoever.
8.56
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