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. C MONWEALTH OF PENNSYLVANIA
. . ... DEPARTMENT OF REVENUE
OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
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RECEIVED ...........................4IIIf.t.. ....If) IO.Imt~.,-_._...-......_....-~ollars.
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
From:----<~..ha .11'.... .....)
-109 u.-"*'. .....-
c.., 1111.... 11011
11.""-'" Dote of Death 8-1-1'"
2 % Tax on $
$
6 % Tax 0 n $
$
15'1() Tax on $
$
~~.. -".JI?8
~ .. II~.
o/() Tax on $
Estate Tax, Act of
May 7, 1927
$
~
$
Name of Decedent
$
_"MO."
County
~r
TOT Al TAX CREDIT
less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_ % from
to
$
~.~.1~
188."
$
MID . ......
lY 00 ~ [p [L~ @ illlJL~
NOTE: This Triplicate Receipt to be rei.ined for .udit purposes.
SEA l
Received by
NOTE: In accepting the transfer inheritance tox on future estates. prior to the death of the life
tenant or tenant for years, as evidenced by this receipt. it is understood that the Commonwealth sholl
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenant for years whenever It appears that such additional tax may be legally due and
CQllectlble for any reason whatsoever.
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