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~IS,S:~}2:F), " 'C'OMMbNWE'ALTH OF PENN~.fNiA
~No:H063762 ";'~EPARTMENTOFREVENU~~;&;,'. .
;~,:, '0,""' OFFICIAL RECEiPT"o;PENNSYLVANIA INHERITAN~):(AND ESTATE TAX
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i RECEIVED ---.......-.............---- ----..---...~----..,.--_..".IiIIl.-..--..dollars
Ii' representing Pennsylvania Inheritance ar
Estate Tax due from the fol19win9 estate: .
=
~
.~
~'At A~d Va~k~t Streets
2 % Tax an $
Date of Payment
.1PlUtaJ"y l5~'979
% Tax an $
Estate Tax, Act of
May 7, 1927
$
$
$
$
$ l
$ 31.75
$
55
CA.mp '{ill JP&.
!70U
6 % Tax on S
15% Tax an $
File No, 21-78..291 Dale af Death 4-15-1918
Name of Decedent
AR'l'1lt.rn '1' .~A~SE
i Cou nty
l!1W'~rhi'1~
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months ofter
dote of death
Plus interest at the rofe of
_%from
ta
rks:
'[j'[M~[P[L~@ill'[j'~
SEA L
TOTAL AMOUNT PAID
$
'-'\l~~TE:,:t"hI. Triplicate Receipt to be (etained for audit purposes.
Received by
NOTE: In accepting the tronsfer Inheritance tax on fulure estotes, prlor to the deoth of Ihe life
'enonl or tenant for yeors, os evidenced by fnls re'elpt, if Is understood that the Commonweollh shall
not be precluded or prevented from hereafter anening odditlonal Inheritonce tax at the "death of 'he
Ufe tenant or lenant for years whenever It gppeQfS Inal such additional tox may be legally due and
collectible for any reason who'soever.
" SJ\lna'~re}
Rlehard ,IS. Anderson
Reg.t,ttr (~t)Wil1il1
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