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I~ RCC4(2177lCOMMONWEALTH OF PENNSYLVANIA
~iNo.H0257.a DEPARTMENT OF REVENUE
B OFFICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE 'TAX
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$ RECEIVED _____-.........--.lf1IO ftOUBAID
,i
I
'MtIl'1'~....._-----._-------...3~1
o ors
representing Pennsylvonio Inheritonce or
Estote Tox due from the following estate:
_......,... 1'1_1' .lobJlll-.""".,
) 2'7. Tax on
$
6%Tox on $
15'J'.Taxon $
e No.
'7. Tax On $
Estate Tax, Act of
May 7, 1927
ote of Poyment
GeWMr 10,1918
Nome of Decedent
LlvaacJ LIVI UMl~
C\IId>>VlaDd
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months alter
dote of death
Plus Interest at the rate of
_%from
to
County
Remarks:
PAD OB AOCOUJ!.
lYOO~~[L~@illlY~
5 E A L
TOTAL AMOUNT PAl
NOTE: Thi. Triplic8te Receipt to be retained for eudit purpose..
Received by
NOTE: In accepting the tronsfer inheritance tOK on future estates, prior to the death of the life
tenant or tenant for years, as evidenced by this receipt, it is understood thot the Commonwealth sholl
not be precluded or prevented from hereafter assessing additional inheritance tox at the death of the
Ilf. tenant or tenont for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoeller.
$
$
$
$
$
$ 1.105.26
$ 105..6
$