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i~II~'~~C 4121771 COMMONWEALTH OFPENNSy'['VTi\ll:o/,;
~ ~~:~O 0 12 5 4 DEPARTMENT OF REVENUE~~~ft~;'i;:' .
~."Z;'w' OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE'AND,ESTATE TAX
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I' RECEIVED ........-...------------>>18 JltJl1DRED
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ij ress 26 s. E1qhth StI"e9t
LAmnrnilll, Pll.
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N'nTTY-ONE & 12/100 . . ,
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
Samuel L. Andilll8, Eaq.
$
$
2% Tox on
6% Tox on
$
$
170JI}
15o/(lTaxon
$
$
File No, 21-78-181
1..19-1978
% Tax 0("1 S
Estate Tax, Act of
May 7, 1927
$
Dote of Death
Date of Payment
Ap..n 'n, , 978
$
Name of Decedent
HENRY C.BRACHMAN.
$
i County
lhnnb.....1An"l
TOTAL TAX CREDIT
less five perce'iltum of tox if
paid within three months after
dote of death
Plus interest at the rate of
~%from
to
$
$
Imm." .p AID
ON ACCOUNT"
.
IY 00 ~ [p [L~ (QjilllY~
SEA L
NOTE: This Triplicate Receipt to be retained for audit purposes~
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Ii
Received by
NOTE: In -accepting the transfer inheritance lax an" future estates, prior to the death of the life
lenont or tenant for years, as evidenced by this receipt, it is understood 11'10' the Commonweallh sholl
not be precluded or prevented Irom hereafter assessing additional inheritance la~ at the death ollhe
life lenont or lenont for years whenever i1 appears that such additionolto~ may be legally due and
collectible for "any reason whatsoever.
R1cha~gl:r .~.on
~Ag'~tA" ~f ~'ll.
(Title)
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.liollors
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1,OJI3.?R
$2.16
1.12
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