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III COMMONWEALTH OF PENNSYLVANIA
III No.H 00 1273 DEPARTMENT OF REVENUE
= OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
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I; RECEIVED
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I File No. 21-18-56 _Dote of Death 1-21-1918
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----~------~----_rBIR!Y-POUR
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(Bar1 W. . K&1IlOftd. 11. Rin .31")
8 B.rth Queen Street
L&ncU'Mr .P&.
11603
Dote of Payment
AprU 19,19'78
Name of Decedent
RA11IOJI1) 11. llIPB. D.
County
Cu.berlan4
'narks,
PAID OK AOCOUft.
uOO~[p[L~@illurn
5 E A l
NOTE: This Triplicate Receipt to be retained for audit purposes.
IIt1IDRED T1dQrtJ; DO'l'.'.A1UI----------~0Ilars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate,
2% Tax on
$
$
6% Tax on
$
$
15% Tax on
$
$
% Tax On $
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 rate of
_ % from
to
3.600.00
$
$
1Rft.OO
$
TOTAL AMOUNT PAID/
I
II
1,
Received by
NOTE: In accepting the transfer inheritance lox on future estates, prior to the death of the life
tenant or tenant for years, os evidenced by this receipt, it is understood thol the Commonwealth sholl
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenant for years whenever it appears that such additional tax may be legally due and
collectible far any reason whatsoever.