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~'I,;)",;,',""O' 01214 ' COMMONWEALTH OF PENNSYLVANIA ,
: NO!f3 ' DEPARTMENT OF REVENUE
. ~rl1:;~,"< ,OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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~ -----..........NINE
1;1' RECEIVED
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THOUSAND sn: 1tUNDRED SDl'!'iiEN 8;
39/100..........--'1iiii......
dollors
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
DOl'oth7 M. Zeigler
1107 Yverdon Drive
2%Toxon $
6 % Tox on $
Camp 8U1.Pa..
17011
150/, Tox on $
F'! N 21-78-14
Ie o.
Date of Death
12-26..1
% Tox on $
Estate Tax, Act of
May 7, 1927
Date of Payment
MUch 11.1.978
NORA M. GARIAND
Nome of Decedenl
County
CUIIlber1and
TOT AL TAX CREDIT
less five percentum of tax if.
paid within three months after
date of death
Plus interest at the rafe of
_%from
to
PAID ON ACCOUNT
TI' 00 ~[P [L~ @ ill TI'~
5 E A L
TOTAL AMOUNT PAID
$
$ \'\9.616.39
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RlCha.rd ~~nokn~eraon
Des1aterot Willa
(Titlo)
NOTE: This Triplic8Ite Receipt to be retained for audit purposes.
t:
Received by
NOTE: 11\ occepting the transfer inheritance tax on future estates, prior to the death of the Ilie
tenant or tenonl for years, os evidenced by this receipt, it is underslood thai the Commonwealth sholl
I\ot be. precluded ar .prevented from hereofter assessing odditional inheritance ta}! ot the death 01 the
Ille tenant or tenant for years whenever it appears that such additional tax may be legally due and
coHectible lor any reoson whatsoever.
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