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C.'OMMONWEALTH OF PENNSYLVANIA
I." .... ,'... . . . .
i'i'(/'"i)i/... . . DEPARTMENT OF REVENUE
'~.At.AECEIPT.' PENNSYLVANIA INHERITANCE AND ESTATE TAX
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1SVJI,-1m ftaltfr...J'1Yi J(P'1..6...------11
_00 ars
representing Pennsylvania Inheritance or
Estote Tax due from the following estate:
II 1M"
2'T. Tax on $
$
6 % Tox on $
$
1T118
Dote of Deoth 6-11-1
15". Tax on $
$
...,.... 18.""
~ 11. 8DLL
% Tox On $
Estate Tax, Act of
May 7, 1927
$
$
~
c:u.Ml'1ull
TOT AL TAX CREDIT
Less five percentum of tox if
paid within three months after
dote of death
Plus interest ot the rote of
_ % from
to
$
1.500.00
$
15.00
tAD . AuuuWtf.
$
lfOO 0 [p [LO @ffi 1f~
5 E A L
~at OIl
aeauwr at 1J:L11a
(Title)
'",,_ Triplicllte Receipt to be retained for audit purpol8l.
Received by
. In occepting the transfer inheritance tax on future estates. prior to the death of the life
t.nont for years, as evidenced by this receipt, it is understood thot the Commonwealth shall
.eluded or. prevented from "'.reoher assessing additional inheritanc$ tox at the death of the
or tenont for years whenever It appears that such additional tox may be legally due and
for-any reoson whatsoever.