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Ill! RCC4(2!77) COMMONWEALTH OF PENNSYLVANIA
~'NO. H l) 01244 OEPARTMENT OF REVENUE
S, OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
U
;, RECEIVED _____________________TWO HUlDRED
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,t ~dr"ss 113 E. lUng 910"0'
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i File No. 21.-76...40
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)m:
(T~' L. Pob'~.on)
JA1pp ell. b'U"g.
p.o
172$7
Dote of Death
Dote of Payment
'1',0011 ~. 1978
Nome of Decedent
OLIVER ALVRRn ROTZ
County
0"...."."'1....,4
,mocks:
"PAID ON AOCOUH~
lJOO~[P[L~@ffilJ~
SEA L
NOTE: This Triplicate Receipt to be retained for audit purposes.
TWEKTY-SEVEN & S8/l00------------do~MS
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
29". Tax on
$
$
6% Tax on
$
$
159". Tax on
$
$
I;
~.
% Tax On $
Estate Tax. Act of
May 7, 1927
$
$
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
dote of death
Plus interest at the rote of
_%from
to
$
227.$6 '
$
$
$
Received by
NOTE: In accepting the transfer inheritance tax an future estates, prior to the death of the life
tenant or tenant for years, os e....idenced by this receipt, it is understood that the Commonwealth sholl
not be precluded or pre....ented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenant for years whene....er it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
\j
(Signature)
R10haN B.. An4ezo8on
R.8b~iWC).t Wl1la
t
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