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RCC 4 (2177) COMMONWEALTH OF PENNSYLVANIA '*'
NoH025860 DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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RECEIVED ---------------- nnT.T_ADO_______________ - - - .Jollors
I representing Pennsylvania Inheritance or
, V"'.l"lI. -- Ao - Estate Tax due from the following estate:
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From: (PRnRlnp. ~u..n V.lb...) 2% Tax on $ $
I"." P,O. RoT 1 :>5 6% Tox on S $ :
T ..,...1\7'"'- . PII. 170/13 15% Tax on $ $
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File No. 21-78-1 J9 Date of Death ~-27-1976 % Tax On $ $
Estate Tax, Act of
i Date of Payment Ma7 :>/1, 19711 May 7, 1927 II
$ E'
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Name of Decedent fl F.'I"I'V AT IUNnFRl'ttJ TOTAL TAX CREDIT $ II ,:>10.5:>
Less five percentum of tox if
County C'!1J...~\Ilt' .'1'\" paid within three months ofter
dote of death $ 210.$2
Remarks: Plus interest at the rote of
t "PAID ON ACCOUlfT" _%from ~
to $ ,
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,
4. 00.00 ,
0 0 TOTAL AMOUNT PAID
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NOTE: This Triplicate Receipt to be retained for audit purposes.
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Received by
NOTE: In accepting the tronsler inheritance tox on future esloles, prior to the deolh of the life
tenanl or tenant for years, os evidenced by this receipt, il is understood that the Commonwealth shall
not be precluded or prevented from hereofter ossessing additional inheritance tox at the dealh of the
Ille tenonl or tenanl for years whenever il appears thai sud., additional tox moy be legally due and
collectible for ony reason whol$oeller.
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