HomeMy WebLinkAbout04-14-78
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RCC.UI40077) BANK NO.
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
DATE FILED
NOTICE OF DECEDENT ACCOUNT STATUS Optional #4105 April 14, 1978
Submit in truplicate within 10 days after knowledge at ST.TITUS OF ACCOUNT NO:; ~~OINT. TRUSTI OR INVESTMENT
the death. oint tenants .,; h "{O'ht of survivorshin not as
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January 1, 1957
RETURN COMPL ETED NAMES ON ACCOUNT SOCIAL. SECURITY NUMBER(S)
'LOGAN, Elisabeth 11. 195-28~2280
FORMS TO LOC AL COUNTY 8. KLINE,' Howard A. , I
INHERITANCE TAX OFFICE I
I
,
SURVIVING DEPOSITOR (Beneficiary) INFORMATION DECEDENT IN FORMA TION
NAME RELATIONSHIP NAME DATE OF DEATH
TO DECEDENT. 3-26-78
Howard A. Kline unknown Elizabeth :.1. Logan
ADORESS Q~ ADDRESS
227 Sus:luehanna Ave., 227 Susquehanna A1J'e.
Eno1a, Pa. 17025 -~
CITY COU N TY
" .- ~.-- .. .. -. ~~. -- '.- Cumbei:land
Eho1a, .Pa. 17025 'i 76~~E
BAN K/INSTI TU TI ON ADDRESS BALANCE OF ACCOUNT AT DOD $ .
The Harris sav~ngs Association INTEREST ACCRUED AND COLLECTIBLE AT 000 $ '73,;t~
205 Pine st., .. Box 1711
Harrisburg, Pat 17105 TO TAL $ '8 / /05. ~
BANK AUTHORIZATION
1 HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REFRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
WITH SECTION 742 F I Ii E TAX ACT OF 1961.
SIGNATUR~3~ FINANCiAL INV~R I DATE
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