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H COMMONWEALTH OF PENNSYLVANIA
H!NO.H026004 DEPARTMENT OF REVENUE
i, OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
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'If RECEIVED
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tl Date of Payment
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representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
LaMu.Lanahe ., IAnahe, At.tJ'8.
2'1. Tax on
$
$
469 LiMen street
6% Tax on
$
$
A'1.ant:.ftWn,Pa.
18102
15%Taxon
$
$
21-18-]6
July 28 .1918
Date of Death
10-2
% Tax On $
Estate Tax, Act of
May 7, 1927
$
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$
Cou nty
C,_ha91an4
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_%from
to
$
'5.~
Name of Decedent
CYRIL J. BRIXIUS
$
Remarks:
$
uw~[P[L~@ffiu~
5 E A l
TOTAL AMOUNT PAID
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NOTE: This Triplicate Receipt to be retained for audit purposes.
Received by
NOTE: In accepting the transfer inheritance tax on future estates, prior ta the death af the life
tenant ar tenant for years, as evidenced by this receipt, it is understood that the Commonwealth shall
not be precluded or prevented from hereafter assessing additional inherilance tox at the death of the
lIfe tenant or tenont for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
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