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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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S' RECEIVED ----..-.~-------NINE
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II File No. 21-78-250
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~ -NIlE a: 14/100-----~-...I....~"ars
representing Pennsylvania Inheritance or
Estote T ox due from the fol/owing estate:
(.Tam.. _.. ..ft&.1.er)
2 % Tax on
$
$
-'9 V.sot ''':In Street
6% Tax on
$
$
MecbluUCO\lrg. Pa.
Dote of Death
17055
5-8-1918
15 % Tax on
$
$
Dote of Payment
.r....ry 2Q,1979
JAl&I L. HERTZLER
J. .iI(1f.~.D ~'7T,1!CR
% Tax on $
If Estate Tax, Act of
May 7, 1927
$
Nome of Decedent
$
~"rltllld
TOT Al TAX CREDIT
less five percentum of tax if
paid within three months after
dote of death
Plus interest at the rote of
- % from
to
$
rks:
$
PAID OB ACeOUJi'J.'.
uOO 0 rP[LO@m u~
$
SEA l
NOTE: This Triplicate Receipt to be retained for aUdit purposes.
Received by
NOTE: In occeptlng the Iron,fer Inherilance tax on fulure estates, prior 10 the death of the life
tenant or tenont for years, os evidenced by Ihis receipt, it is understood that the Commonwealth sholl
not be precluded or prevented from hereafter aSSessing additional inheritance lox 01 Ihe death of the
life lenant or tenant for years whenever If appears thaI such additional tax may be legally due and
collectible for any reason Whalsoever,