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RCC 4 (2/77)
, I COMMONWEALTH OF PENNSYLVANIA
0)1063549 DEPARTMENT OF REVENUE
OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
RECEIVED
-------------------'1'110 ~ 'f1IBftY..on . 15/100--------dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
Fr
J_a D. _..... "q.,
2'7, Tax on $
Date of Payment
Maroh 30.1979
% Tax on $
Estate Tax, Act of
May 7, 1927
$
$ ~
$
,
$ ~
$ ~
$ 121.15
Ad ess
23 V.at Ma1n stne1;
6 % Tax on $
File No.
~.town.Pa. 11011
21 18-458 7-5-19T8
.... Date of Death
15% Tax on $
Name of Decedent
.... ""'..II! 'JTAWDP
County
C\llber1and
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_%from
to
$
'arks:
PAID 011 ACCOUft.
lrOO ~ [p [L~ @m lr~
SEA l
TOTAL AMOUNT PAID/
$
I,
NOTE: This Trlplicete R.ceipt to be retelned for eudlt purpo....
Received by
NOTE: In accepting Ihe Ironller inherllonce lox on luture elloles, prior 10 Ihe death of the life
t_nl or tenonllor years, 01 evidenced by Ihis receipl, ills understood thollhe Commonweollh sholl
not be precluded or prevented Irom hereafter assessing addilional Inherilonce lox 01 the deolh 01 the
life tenant or tenonl lor Ylors whenever II appeors Ihot such addillonol lox moy be legally due ond
CIOII,cllblelor any realon whalloever.
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