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(:.1~}i"Oi2' 5'986' .... / .' COMMONWEALTH OF PENNSYLVANIA
;N911tl .zi~ll.tl;!i!l~4', ,DEPARTMENTOF REVENUE '
I >S:.;,,';.,,' ,'JOFFICIAl1RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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., '''-'''''''''''----'-.;-'
~,
,~' RECEIVED
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= From:
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,
ress
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*-------.--.--.-~.NINE
<<CNB"-N. A.
21st & Ma.rket Streets
camp Hill;pa.
17011
21"78-16
Date of Death 12-14..19
Date of Payment
July 21,1978
Name of Decedent
STEPHEN B. SHOVER
Cou nty
Cumberland
PAm ON ACCOUlfi'
'[]'rn~[p[L~@ill'[]'rn
5 E A L
NOTE: Thill TriplicDte Receipt to be retained for audH: purposes.
.;..
IIUNDREJ) TWENTY SIX &: 41/100--..-..-....-.."
dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
2% Tax on
$
$
6% Tax on
$
$
15'1'0 Tax on $
$
% Tax or $
Estate Tax. Act of
May 7, 1927
$
I
$
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
date of death
Plus interest at the raf'e of
_%from
to
3,926.41
$
$
$
TOTAL AMOUNT PAID
I
I
~
Received by
NOTE: In accepllng the transfer inheritance la~ on fulure eslales, prior to the death of ihe life
tenant or tenant for years, as evidenced by Ihis receipt, it is understood that the Commonwealth sholl
not be precluded or prevented from hereafter assessing additional inheritance tox 01 the dealh of the
life tenont or tenanl for years whenever it appears thai such additional ta~ may be legally due and
collectible for any reason whatsoever.