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RECEIVED
. ........IIll.............IJ'ilII~l...,. .~ ...,.~~. .................dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
From:
.hn $
2% Tax on $
6% Tax on $
1"" 15'10 Tax on $
$
~ddress
~ IIId.d .....n $
....l. ,...r1.IIItlI....
File No.~Date of Death~
Date of Payment ~ T.I:.'"
Name of Decedent ~.. alIB-
% Tax on $
Estate Tax, Act of
May 7, 1927
$
$
County
. '" -....
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
$
','P.-
$
lJ>>,.,a
Remarks:
aD. MCHUd'.
IYOO~ [p~~@glY~
SEA L
TOTAL AMOUNT P
$
NOTE: Thi8 Triplicate Receipt to be retainec:l for 8udit purpoaea.
Received by
NOTE: In accepting It,.. transfer Inheritance tax an future estates, prior to the deoth of the life
tenant or tenant for years, as evidenced by this receipt, it is understood that the Commonwealth shall
not b. precluded or prevented from herealter assessing additional inheritance tax at the death 01 the
life tenant or tenant for years whenever It appears that such additional tax may be legally due and
collectible for any reason whatsoever. "
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