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UIi~:,'Ii);>;C:.' . COMMONWEALTH OF PENNSYLVANIA
~; NO:.ti1 0 63 610 ' DEPARTMENT OF REVENUE
;~ltl;1:N5,:*,j;:iJOFFICIAL RECEIPT. PENNSYLVANIA IN, HER,ITANCE AND ESTATE TAX
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ii, RECEIVED --................__....l'our Hundred
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Fitty..six & OO/lOO..-................---..-..--...dollors
representing Pennsylvonia Inheritance or
Estate Tax due from the following estate:
Commonwealth Na.tional Bank
3 Norlh Hanover Street
CarlialftjPa..
1710~
No,
21-18-220 Dote of Oeoth 1-21..1918
()t>toM" 31;'978
Name of Decedent
El'l'HRD I. FO!l~
CumberlAnd
County
Remarks:
PAm ON ACCOUN'l'.
'[j'OO~[p[L~@E\'[j'rn SEAL
OTE: This Triplicate Receipt to be retained for audit purposes,
2% Tox on
$
6% Tax on
$
15o/,Toxon $
% Tox 00 $
Estote Tox, Act of
Moy 7, 1927
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
dote of deoth
Plus interest 01 the rale of
_%from
to
$
$
$
$ ~
$ I
$ 480.00
$ 24.00
$
TOTAL AMOUNT PAID
Received by
NOTE: In accepllng the transler Inheritance lax on future estahU, priar to the death al the life
tenant or tenont lor years, as evidenced by this receipt, It Is understood that the Commonwealth sholl
flat be precluded or prevented from hereofter assessing additional inheritance lox at the death of the
life tenanl or lenant lor years whenever it appears thot such addmonol tax may be legally due and
collectible lor any reason whatsoever.
R1char4Sir:tu de1'80n
ReliA~~r ofW111a
(Title)