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~lj~~~1CC,412177l COMMONWEALTH OF PENNS~iA
11 tlOH 0 01233 DEPARTMENT OF REVENUEi~~0' f~,;:
a,'i, " OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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~ RECEIVED ------..--- ...... .. -
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representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
Phyl1i. l. Mn~t.~~
25'l?Toxon
$
R.n.1I6, Box 104
. 6 % Tax on $
CAl'l1ale.
Pa. 17011
15'!', Tax on $
F;le No, 21-78..12
Dale of Death l-Q-1q76
% Tox 0{1 $
Estate Tax. Act of
May 7, 1927
Date of Payment
MRl'Bh )0, 1~78
Nome of Decedent CHARLES EDWIN JONES
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after.
dote of death
Plus interest at the rare of
_%from
to
County ntmlhAltlllnd
'D'ill ~ [PLl~ @ill'D'~
NOTE: This Triplicate Receipt to be retained for audit purpoS8$.
SEA L
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Received by
NOTE: In accepting tne transfer inherilom:e tox on future eslales, prior to Ihe death of tne life
lenont or tenant for years, os evidenced by this. receipt, it is understood that the Commonweoltn snail
not be precluded or prevented from hereafter oueuing additional inheritant(1 tax at the death 01 the
life tenant or tenant lor years whenever it appears that such additional tax may be legally due and
caIJeclibJe for any reason whatsaeyer.
R1cha~ifnji,:e
R~gi '" t..!.... (>1'
(Title) .
$
$
$
$
$
$
$
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16.98
.85
16.13
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