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= RECEIVED_-===--=-=--:=-:::-_TWEN'!'Y_FIVE HUNDRED TWENTY ONE &I 42/100--------__dollars
" repcesenting Pennsylvania Inheritance or
'= Esfate Tax due from the following estate,
ilJl' From. .fllm.. 'R - Unma"" J J?aq _ J
1/ ( Pearl Brymeuer)
III Add'e" :1
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COMMONWEALTH OF PENNSYlVAN1A::::~:.:~:
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DEPARTMENT OF REVENUe .... . .' ,>",'\:.:~0
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OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCEANO'~ST'A~~:r~~:::::::*>:'fllI~
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2% Tax on
Carl1s1e,Pa.
17013
6% Tax on
o.
21-18-126 Dote of Death,2-26-1918
15% Tax on
of Poyment -----.ol'Ul,y 16 .1919
$
$
$
Name of Decedent
~E BURGE'l'T
% Tax on $
Estate T ox, Act of
May 7, 1927
County _
Remarks:
TOTAL TAX CREDIT
less five percentum of tax jf
paid within three months after
dote of death
Plus interest at the rote of
~%from NOV. !)6.l9?8
'0 .T..~ 16.1979
Cumberland
PAID IN Ft1LL.
(.03
uOOOIP[10@mu~
5 E A l
TOTAL AMOUNT PAID
NOTE; This Triplicate Receipt to be retained for audit purposes.
Received by
NOTE '0 '''.p''og ". ,,,,,f., 'oh"",,,. ,,, " f"". ",ot." P"" '0 ,h. deo'h of 'h. IIf.
'00001 " "0001 foe y."', " .,'d'".d by 'h" ""'P', II " "d""ood 'hot ". C,mm"weolth ,h,II
oot b. P"",d.d " P'''oo'.d "'m h"eof'" o"''''og oddll'oool 'Oh""",, ,,, 0' ". deo" 01 'h.
IIf. '00'" " '00'" foe y.'" whoo.." II 'ppeo" 'hot '"h oddll'"o' ,,, moy b. '.golly doe "d
collectible for any reason whatsoever.
$
$
$
$
$ ~
$ !)1~]1.,O
$
$ a9.,.
$ !) ~O1 .II.
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