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'II' COMMONWEALTH OF PENNSYLVANIA
:~: NO. H 0 6 3512 DEPARTMENT OF REVENUE
,; OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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'* RECEIVED
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S File No. 21-78-135
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. 901100-----------------___
-------------SEVEN HUNDRED SIXTY-SIX
Donald B. OWens,Esq.,
(Joseph M. Morrison)
Box I/: 327
Summerdale,Pa. 17093
2-4-1978
Date of Death
MArch 20,1979
Name of Decedent
CHLOE E. ANDREWS
rks:
CUIIlberl&nd
( .022
lJOO~[P[l~@mlJ~
SEA L
Dote of Payment
NOTE: This Triplicate Receipt to be retained for auaH: purposes.
dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
2 ere Tax on
$
$
6%Tax on
$
$
15% Tax on
$
$
% Tax on $
Estate Tax, Act of
Moy 7, 1927
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e
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$
$
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
dote of death
Plus interest at the rate of ,,8
% from November 9,197
to !ofarch io!3,~979
$
750.12
$
I
$
16.78
II
I
,
TOTAL AMOUNT PAID ~
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ll{\ (.'
~ LClLA'OV~
. RiChaZ'dSiE'~tu . araon
Regiater of Willa
Intle)
766.90
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Received by
NOTE: In accepting the tronsler inheritance to)<; On future eslates, prior to the deoth 01 the life
tenant or lenontlor years, os evidenced by this receipt, il is understood thai the Commonwealth sholl
not be precluded or prevented from herealter assessing additional inheritance 10)<; ollhe deoth of the
life lenont or lenont lor yeors whenever It appears thaI such additional tax may be legolly due and
collectible for any reason whotsoever.
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