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II COMMONWEALTH OF PENNSYLVANIA
i,IINO,H025184 DEPARTMENT OF REVENUE
;; OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
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mnmR'lm
lflOR'I'V-tnI'R . 12.1100..__________.____
representing. Pennsylvonia Inheritance or
Estate Tox due from the following estate:
dollars
Daupb1A Depolfit :a.nk.
2% Tox on
$
213 NU'lt.t st"et
6%Tox on
$
Harrisburg.fa.
lno5
$
15o/cTaxon
21 -78_?.143 Dote 01 Death 4-23-1918
% Tax On $
Estate Tax, Act of
Moy 7, 1927
ate of Payment
OCltoMr lO~1-918
Name of Decedent
ISAlmT. BI\~t'!K
TOT AL TAX CREDIT
Less five percentum of tox if
paid within three months after
dote of death
Plus interest 01 the rate of
_%from
to
County
Remarks:
TOTAL AMOUNT PAII1 ri
I (>;/1
\ ~^ t/"
Richard :i~gn~~:raon (
Reg1.ter O(t ~tl].
Itle
l!l''M'ha..1 ant!
PAID OR ACCOUll't.
,[],OO~[PG:,~@m'[]'~
5 E A L
NOTE: This Triplicate Receipt to be retained for audit purposes.
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II
Received by
NOTE. In accepting the transfer inheritance tax on future estates, prior to the death of the life
tenant or tenant for years, os evidenced by this receipt, it is understood that the Commonwealth shall
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
Ille tenant or tenant for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
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