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"~'E)FpENNSYLVANtA:
. Tft'i~N'J;oFREVENUE '. .
,+ .~Al!Iij\Jl\IHERITANCE AlIID ESTATE TAX
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S RECEIVED _--------------.J1"RRlI!R
'I
mnm~lm 'l"Wi'l &:
h.F\ I' 01'-..------------------- dollors
rep.resenting Pennsylvania Inheritance or
Estate Tax due from the following estate:
From:
(1t1CMH. C1ugh)
Address
5 East King Street
ShippenabtIri,Pa. 17251
2%Toxon $
$
6%Toxon $
$
No. 21-78-606
Dote of Death 1-29-1978
15% Tax on $
. $
(
[ ,of Payment Ju:Lv 11.1979
Nome of Decedent MABEL J. CLUGH BJ.'.cI'l.lSlt
% Tax on $
Estate Tax, Act of
May 7, 1927
$
$
County
Cl1mM'l'land
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
dote of death
Plus interest at the rate of
_%from
to
$
~02.48
Remarks:
PAID ON ACCOl.J!IT.
$
$
\.'
uOO~[P[L~@illu~
5 E A L
TOTAL AMOUNT PAID.
$
~OP_!lq
NOTE: This Triplicate Receipt to be retained for euctit put'pOSeS.
-
Received by
NOTE: In accepting the transfer inh.ritance tax an future estates, prior to the death of the life
tenant or tenant for yeors, 0$ e...idenc:ed by this receipt, it is understood that the Commonwealth shall
not be precluded or pre....nt.d from h.r~.r assessing additional inherllance tax at Ihe death of the
llf. t.nant' or t.nant for y.ors whene...er it appears that such additional lox may be legally due and
collectible for any reason whatso.ver.