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III ~ (<.';~\l~li COMMONWEALTH OF PENNSYLVANIA
tll No.,1 0636 5 7;SI~I':L DEPARTMENT OF REVENUE
ial OF"~I~LRECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE
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'III' RECEIVED ------..........-...-....... "
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"...q'WO HtJBD'JilD SBVD'!'Y....IX as ", iloo....__.........lII........do/lors
representing ~nsylvanio Inheritance or
Estate Tax due from the following estote:
(Barbara A. .111h1de )
Post ortt. Box # 336
2% Tax on
$
$
(,;'"
6 % Tax on
$
$
Sh1ppenalraa.Pa.
17251
15<f~ Tax on
$
$
21-18-580 Date of Death 10-14-1912
Date of Payment
lfov...... 29_1918
% Tax On $
Estate Tax, Act of
May 7, 1927
$
$
Name of Decedent
cr~DICS If. VIt.T}lIJ)S
(34.
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the role of
% from .July 14.1913
to December 1.1978
$
.....
County
C__l"l."d
Remarks:
$
)
l
$
71._
urn ~ [P[L~@ffi u~
SEA L
$
OTE: This Triplicate Receipt to be retained for audit purposes.
Received by
NOTE: In accepting Ihe transf.r Inheritance lax an fvtvre estates, prior to the death of the li/e
tenant or tenant for years, as evidenced by this receipt, it is understood that the Commonwealth sholl
not be preclvded or prevented from hereafter assessing odditlonal inheritance tax ot the death of the
Ille tenant or tenant for years whenev.r II appears thot svch additional tax may be legolly due ond
collectible for any reason whatsoever.