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'1~I}ACC412/771 COMMONWEALTH OF PENNSYLVANIA
r.i N3.H 001186 DEPARTMENT OF. REVENUE
~;"'""." OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
II
!.l.
. '---~_.-.-----~~..-~O THOUSAND
'VI RECEIVED
If
..;....
"'-""',
DOLLARS~---------_.-..-_____.e_-
dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
(Forrest E. Coble)
2%10x on $
$
317 Th1~d. stnet
6%Tox on $
$
New cUIlIberUnd.Pa. 17070
15% Tax on $
$
21-78-10
\, Dote of Deot\1
12-27..1
% Tax 0(1 $
Estate Tax, Act of
May 7, 1927
$
Dote of Payment
tlal'Ch 8,1978
FRANCES M. COBLE
$
I
'fCOU::kS'
"
'.
C1.UIIberlan4
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
dote of death
Plus interest at the rofe of
_%from
to
$
2.105.26
Nome of Decedent
$
105.26
PAID ON ACCOUNT.
ItlcbU4 lJinoJ.tld.nOn
Rceg18'ter Of W111a
(Title)
lJ'OO~[?~J@&lY~ SEAL
NOTE: This Triplicate Receipt to be retained for audrt purpose$..
,
I
Received by
NOTE, I" cccepting Ihe Ironder inheritance tax on future eslales, prior to the death of the life
lenont or tenant for years, as evidenced by this receipl. il is understood lhot Ihe Commonwealth sholl
not be precl.uded or prevented from hereafter assessing oddilionol i"hol!ritQ~e tox 0\ the dec\h of Ihe
me lenont or tenant for yeors whenever it oppearS that such additional tox moy be legally due and
colleclible.for any reO$on whatsoever. .