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RCC 4 (2177) COMMONWEALTH OF PENNSYLVANIA '*'
No.H063745 DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX . .
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RECEIVED --------------SIRE~ HUNDRED ~vEN'l'Y-EIGH'1' &: 49/l00------------"1l01l0rs
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
,Jess ,
Robert Trace) EsQ.) 2% Tax on $ $ !
111 Locust Street 6%Toxon $ $ ,
I Harriaburg.p&. 15%Taxon $ $
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~ File No. 21-78-84
Dote of Poyment .1&.1'\"...." 5 ~1979
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Dote of Death
1-7-1978
Nome of Decedent 'N'1f!T.T.TR MAY N'RT_ClOU
County Cnm'her' And
Rlrks
PAID ON ACCOUNT.
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NOTE: This Triplicate Receipt to be retained for audit purposes.
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% Tax on $
Estate Tax, Act of
Moy 7, 1927
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$
$
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest ot the rate of
_%from
to
1,678.49
$
$
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$
TOTAL AMOUNT PAID
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Received by
NOTE: In accepting the tran51er innerilance te>: on fulure estates, prior 10 tne death of the life
lenenl or tenent for yeOr5, os evidenced by this receipt, it Is underslood that the Commonwealth shall
not be precluded or prevented tram hereafter essessing addilional innerilance ta>: allne deoln ollhe
IIle lenonl or lenonl for year5 wnenever II appears that such additional lax may be legally due and
collectible lor any reason whetSoever.
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