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RECEIVED ---------------------------E~rEl\T
&
.40/100----------------------oIoIlors
representing Pennsylvania Inheritance or
Estate Tax due-from the following estate:
% Tax on $
Estate Tax, Act of
May 7, 1927
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of deolh
Plus interest at the rote of
_%from
10
Q~21 IUk DrivA
2%Tax on $
sprinqfielA. Vi~iftiA 2215~
6% Tax on $
File No.
15% Tax on $
21-79-277 Date of Death
Date of Payment MArt!h 20, 1980
Name of Decedent MIY>'\>iO No Cl\SSENS
County CumbArland.
Remarks:
"PAID IN FULL"
voo ~ [p [Ln@illurn
$
$
$
$
$ l
$ 1JI4O
$
$
5 E A L
TOTAL AMOUNT PAID
$
11.40
NOTE: This Triplicate Receipt to be retained for audit purposes.
t
Received by
NOTE: In- accepting the transfer inheritance lOll an future eslates, prior to the death of the life
lenanl or tenanl far years, as e...idenced by this receipt, it is understood that Ihe Commonwealth sholl
not be precluded or pre...ented from herealler assessing additional inheritance tax al the death of the
life tenant or lenant for years wh.ne....r II appears thot such odditianal lox may be legally due and
collectible for any reason whatsoe...er.