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" RECEIV~------------------""-.V'''''''&
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a From:
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i,C 'NO' Di1J..~,
" 11-18-". Date of Death 11-15-114'
(1Iu1... D.
Address ..0. .. 288
.. Oo.--..----...--.....--.-..----.....-....-~o 110 rs
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
29'. Tax on $
Date of Payment __~ 11. I'll
% Tax on $
Estate T ox. Act of
May 7, 1927
$
$
$
$
$ ~
$ .&0..01
...
1101'
6% Tax on $
15%Taxon $
Nome of Decedent "ll"ll-- ~... CD.
County
C....rlaDl
TOTAL TAX CREDIT
less five percentum of tox if
poid within three months after
dote of death
Plus interest at the rote of
_% from
to
$
Remarks:
..AD O. acoou...
J
$
VOO~[P[]J@illV~
5 E A l
TOTAL AMOUNT PAID
$
40.01
NOTE: This Triplicate Receipt to be retained for audit purposM.
Received by
NOTE; In occepting the transfer inheritance tox on future estates, prior to the death of the Iif.
tenant or tenant for years, os evidenced by this receipt, it is understood that the Commonwealth shall
not b. precluded or prevented from hereofter assessing additional inheritance tOl( at the death of the
Ilf. tenant or tenont for yeon whenever It appears thot such additional tox may be legally due and
collectible for any reason whatsoever.
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