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~RCC4(2177) COMMONWEALTH OF PENNSYLVANIA
lvNoH063781 DEPARTMENT OF REVENUE
a .' OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX
b.~"
; RECEIVED
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: ---<ta~. aftII .T..__ --"'AMI'l--- 2 9'0 Tax on $
.........-...-.------POUR HUlIDRBD 8IX'1'Y-PIVI .. 86/l00-----------"!lollars
representing Pennsylvania Inheritance or
. JohMon At' a. tote Tax due from the following estate:
Poa't Off1-e. JIGS 1115 6% Tax on $
'--me.". 11<*3 15% Tax on $
File No. 11-18-400
Dote of Death~
Dote of Payment
.1'arnIU7 a6 .1979
Nome of Decedent ~... I.BYI BAJlAI'!ItII!R
"'_kat.., a.wuI
rks:
llOO~[P[L~@ffill~
SEA L
9'0 Tax on $
Estate Tax, Act of
May 7, 1927
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_%from
to
$
$
$
$
$ I~
I
$ 465.86
$
$
Received by
NOTE: 'n accepting the tran.t.r Inheritance tax on future Istates, prior to the death of the 11ft
tenant or t.nont for yean, as evidenced by thil recllpt, It Is understood thai the Commonwealth shall
not b, precluded or preyented from hereafter OUIsslng additional Inherltonce tax at the death of the
11ft 'Inan' or tenant for Ylars whenever It appears thot sucl'l additIonal tax may be legally due and
collectible for any realon whatsol..er.
NOTE: Thl. Trlpllclte Rlceipt to be retllned for ludlt purpo....