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...>"............ COMMONWEALTH OF PENNSYLVANIA
'U. . ... DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
i RECEIVED .----.Jf~
H
gyM ...... umr-aIX It 00 OO---------dollars
representing Pennsylvania Inheritance or
Estate Tax due from the fallowing estate:
From: ----1~'h...... B. Be'buOk)
dress 5 IIortb ... .,net
20/0 Tax on $
$
6%Toxon $
$
Cb.......l'llburI.Jl&.
11101
6-U-l9T8
% Tax On $
Estate Tax. Act of
May 7, 1927
$
$
15% Tax'on $
~
.
11..18-310
$
Date of Death
......--'-1' 1,1978
JULIA a. ,r.
Date of Payment
Name of Decedent
County ~1aDd
Remarks:
$
1,".00
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months alter
date of death
Plus interest at the rate of
_ % from
to
s
",.00
'AD . AOCOUft.
lYOO ~ [p [L~ @illlY[g
5 E A L
TOTAL AMOUNT PAID
NOTE: This Triplic:8te Receipt to be retained for audit purpooes.
Received by
NOTE: In accepting the tronsfer inheritance tox on future estates. prior to the death of the life
tenont or tenant for years, os evidenced by this r.celpt, it is understood thot the Commonwealth sholl
not b. precluded or prevented from h.reafter assessing additional inheritance tax at the death of the
11f. tenant or tenant for years wheneyer it appears thot such additional tox may be legolly due and
collectible for any reason whatsoever.