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COMMONWEAL TH OF PENNSYL V A.N!A
DEPARTMENT OF REVENUE
HARRISBURG
REV-475 (8-78)
CERTIFICATE
UNDER
REVENUE ACT OF 1926
Date March S. 1979
TO THE UNITED STATES COMMISSIONER OF INTERNAL REVENUE:
Susan R. Jones
THIS IS TO CERTIFY that in the estate of
File No: 21-78-0271
late of Ctmber1and
County, Pennsylvania,
who died May 15. 1978
, no refund of
inheritance taxes has been authorized by the Department and/or by the Board of Finance and
Revenue of this Commonwealth; and that there is no claim now pending for a refund of such
taxes in said estate,
Subject to additional tax, if any, under the Act of May 7, 1927, as amended.
Total Tax
Imposed
Amount Paid
in Cosh
Dote Paid
Discount
Allowed
Interest
Charged
On Account
$12,000.00
2/13/79
For
SEAL
Howard A. Cohen
Secretary of Revenue