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:=: RECEIVED -------------------lfID II
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00.................... ---............---......----.......---- - dollars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
2~ W..t Xing Str.et
2 9'~ Tax on $
of Payment
Jun. 1.1979
% Tax on $
Estate Tax, Act of
May 7, 1927
$
$
$
$ ~
$
$ 9&17
$
SblppenaburlhPa. 17257
6 % Tax on $
21-78-565
Date of Death 7-1_-1978
15% Tax on $
Name of Decedent 1iA.L'l'D B... OB'l"BL
County
Cumberland
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_ % from
to
$
Remarks:
PAm III PULL.
uOO ~ [p [L~ @ill u~
SEA L
TOTAL AMOUNT PAID $ J~ Tf
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a..i_tar of WiI)-
(Title)
OTE: This Triplicate Receipt to be retained for audit purposes.
II
Received by
NOTE: In accepting the transfer inheritance tax on future estates, prior to the death of the life
tenant or tenont for years, os evidenced by this receipt, it is understood that the Commonwealth sholl
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenant for years whenever it appears thot such additional tax may be legally due and
collectible for any reoson whatsoever.