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RECEIVED.....-....... ........llm........
F. 11: ~__lta.. 'tiU8tt
..tiottlc. ....'.2961
Co.,
f A
'ess
~......,.. lTlO5
File No. 21-~ Date of Death 11.16-1
Date of Payment
Mt.:Nh 15.1m
MAD' ..,AD CHJr8JfALL
CwUWlahd.
Name of Decedent
C 1ty
R. Jrks:
PAD 01 AeCOUft.
1YOO n [p [Ln @ill tr g
SEA l
NOTE: This Triplicate Raceipt to be retained for audit purpOl8l.
.'ji~~..'''""."".--_.._-...,._--""
dollars
representing Pennsylvania Inheritonce or
Estate Tax due from the following estate:
2 <<Yo Taxon
$
$
6% Tax On
$
$
150/0 Tax on $
$
C}'o Tax on $
Estate Tax, Act of
May 7,,1927
$
$
4
TOT AL TAX CREDIT
Less five percentum of tax if
paid within three months after
date ofdeath
Plus interest at the rate of
--'- % from
to
2.000.00
$
$
100.00
$
TOTAL AMOUNT PAID
,
Received by
NOTE: In accepting the transler inheritance tax an luture estates, prior to the deathoHhelile
tenant or tenant ,lOr years, as eV,ldenced by tl-lis receipt, it Is understood that the Commonwealth shall
not be precluded or preventedlram herealter assessing additional inheritance tax at the death 01 the
ille tenant or tenant lor years whenever It appears that such additional tax may be legally due and
collectible for any reason whatsoever.
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