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'25903 iCOMMOND~~#tftTO~:E~~N~~Y[VANIA
~~;;'~~}';i2 OF~ICIAL RECE~PT:Jli~~~~~VANIA INHERITANCE AND ESTATE TAX
RECEIVED
~. From,
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.-----------.--~o HUNDRED
Mar" K. Bollingerj
101 WilSon street
C&i'l1s1e,Pa.
11013
21..18-4
11"9..1m
Date of Death
Dote of Payment
June 1!;.1978
? Name af Decedent J. DIEHL BURKHOLDER
I County
Remarks:
CUll1berlAnd
'!Joo ~ [P[L~@ill'!J~
SEA L
NOTE: This Triplicate Receipt to be retained for audit purposes.
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F1l''1'f-FGtIR & 40/100..-....-..................-..
dollars
representing Pennsylvania Inheritance or
Estate Tax due from lhe following estate:
2%Tax on $ $
6% Tox on $ $
159"0 Tax on $ $
% Tox On $ $
Estate Tax, Act of
May 7, 1927 $ ~
TOTAL TAX CREDIT $ 254.40
Less five percentum of tax if
paid within ,hree months ofter
dote of death $
Plus interest at the rofe of
_%from
to $ ~54.40
TOTAL AMOUNT PAID
I
Received by
NOTE: In accepting Ihe lronsfer inheritance tax on future estates, prior to the death of the IHe
tenont or tenant lor yeors, os evidenced by this receipf, it Is understood that lhe Commonwealth sholl
not be precluded or prevented from hereafter ouessing additional inheritance ta;o: at the death 01 the
liFe lenont or tenant lor years whenever it appears thai such additional tax may be legally due and
collectible lor ony reason whatsoever.
f
R1chl~ng~re Merson
Regiliter Of' WillS
(Title)
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