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'1'1 02 746 COMMONWEALTH OF PENNSYLVANIA
No.H 5 DEPARTMENT OF RElIENUE
a . OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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RECEIVE~-------------------THIR TY' -FIVE HtJHDitED OOIURS-----------------
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
Dote of Payment
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7 ~
David R. Dodd, Eaq.,
21k Tax on
$
s
reS5
3133 Che.tnut Street
$
6'k, Tox on
s
Camp H1l1,Pa.
17011
15% Tax on
$
$
21-78-173
4-2-1978
'k Tax on S
Estale Tax, Act of
May 7, 1927
Date of Death
$
October 3.1978
$
3,500.00
Nome of Deceden,MlRD!:rH LUCILLE PRICE
Cou nly
Remarks:
CUIIlber1and
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
dole of death
Plus interest at the role of
_%from
to
$
dollars
)
TOTAL AMOUNT PAID 1 d $ ~:~ _~oo
Received by \ LtYJAA~/!
NOTE: In occepting the Ira'li'.r inherilance tOl< on lulure estales, prior 10 ,he death of the life R't hard ilgAiitf~
lenonl or lenonl lor yeOrl, os e...idenced by this receipt, il is underSlood Ihol Ihe Commonwealth sholl C ~ BOn
not be precluded or pr....ented from herealler ouessing oddilionol inherilonu lox allhe dealh af ,he Reg1ater of Willa
life lenont or lenont for years whene....r it appears Ihal suen additional tax may be leg oily due and (Tille)
collectible lor any reason whatsoe...er.
$
$
PAID ONACCOUNT.
u rn ~ [P [L~ @illTI'rn
5 E A l
OTE: This Triplicate Receipt to be retained tor auDit purposes.
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