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HomeMy WebLinkAbout05-01-78 (3) '. RCC-42 (4-77) .'-' "",t"'~, COMMONWEALTH Of: PE""NSYLVAHIA DEPARTME NT OF REVENUE MAY BA.NK NO. DATE FILED NOTICE OF DECEDENT ACCOUNT STATUS Submit in truplicate within 1 the death. RETURN COMPLETED FORMS TO LOCAL COUNTY INHERITANCE TAX OFFICE NAME SURVIVING DE"POSITOR (Benefl~l(lry) 'INFORMATION RELATIONSHIP TO DECEDENT. Son Merlin L. McCulloh ADDRESS /0--/57-J ;2-/- 7 f-;1;>J- R1 ~ik-k. ~.<h'- ~. State capital Savings & Loan Assoc. 108--114 North Second Street Harrisburg, Pa. 17105 120 S. 15th Street Camp aill, Fa. 17011 BANi(IINSTITU'TJON ADDRESS 5-10--78 ES STATUS OF ACCOUNT NO: {JOINT, TRUST, OR INVESTMENT NAMES 0 A N Abbie S. McCulloh Merlin L. McCullOh r SOCIAL SECURITY NUMBER(SI 355-09-2219 DECEDENT INFaRMATI N NAME: Abbie S. McCulloh ADDRESS 1939 Walnut Street CITY BALANCE OF ACCOUNT AT 000 INTEREST ACCRUED AND COLLECTIBLE AT DOD TO TAL DATE OF DEATH 4":10-78 COUNTy ZI $ $ $ 16,600.00. 20.ElJ BANK AUTHORIZATION I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD WITH SECTION 742 PIa. E TAX ACT OF 1961. SIGNA.TURE 'OF FINANCIAL INVESTIGATOR / _.It" ./ /1/,..-. .' ,,( I .r""" DATE F . ,.. .. :UO p..I!nba.l S! ....ode.. oN '(p8ppD 1!ID~dw3) .,'(00.. "DIIDP p"'pun~ ""'~I P"~xa IOU ""Op ~1D8p I" "w" .'il 4D iliad., 8'14 U.IIM JUR03:11D 'I:tRI 01 p.l06... 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'~IIDnpIA'pu, '''p8~p ,,~ ~q PI.~ Iluno~~y (E 00'0(1;$ '.pun .~uDloq 0 ~II'" "lunOOOD IUlor Q: '1IunOOOD "Il'" puo puoq.nH (l ',.,"od p.,~ puo .11'" puo puoq.n~ ~q Pl"~ Iluno~~y (S '~'Oj O. pUD "Iuno:):)o ."DII' 'Hlodap fO 'BJD:) !f!4J8:) SD '13"1 '1Iuno:):tD ...uauq,S8"U! IU!Or (tr "unoo>y ,....1 (E Ilunoo>y 6u!~~,,~::> Iu,or <t Ilunoooy .6U!ADS IU!Or (I 'l96l ~O 1::>Y XYl31Y1S3 aNY 3::>NYlIH3HNI 3H1 ~O ZI'l NOl1::>3S :uo p.",Rb... '! ....od..1 y ;:0. 7 ~\ ,t"P 1" :."'" '" RCC.U .....77) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 'i' DATE FILED NOTICE OF DECEDENT ACCOUNT STATUS -, <.~ RETURN COMPL ETED FORMS:TO LOC-ALCOUNTY INHERITANCE TAX OFFICE ....,.. ',.,'.., NAME SURVIVING DEPOSITOR (B_ellol.",) INFORMATION ~, t RELA,TIONSHIP TO"'DECEDENT. MerlinL"McCtillbh " '. son' AO'DRESS '126 S:....i'5tilA St~.-.:.-~'~.~" .- Camp Hill, Pa. -17,011 . t;.i!'"",!""_.~.""" ~ .::: ~" .,.: . i' ~,. ,", .~. BANK/INSTITUTION ADDRESS ~ i!'~' . The HarrisbSavings Assn. P.O. Box 1711 Harrisburg, Pa. 17011 May.l, 1978 STATUS OFACCOUNT NOI WOINT, TRUST, OR.INVESTMENT 4-1 - 1+ NAMES ON ACCOUNT SO CIAL SECU RI TY NUMBER(S) " OAbbie'S. McCulloh Merlin L. McCulloh 0340:-30-0848 OECEDENT INFORMAT ON NAME DATE OF DEATH ~.... j .;.~ ..~ .';-. Abbie S: - MciC 1 ADORES ~. , 1 9 \,~'i~uCSt. ,,~ -# .......,; CITY COUNTY . -f" '- Camp Hill, .:-Pa. BALANCE O.F ACCOU.N:T AT 000 INTEREST ACCRUED AND COl.l.ECTIBl.E AT 000 TO~T..Al. z 17011 $ $ $ G,G06"G6 120_/1 . , - BANK A:UTHORIZA TION I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A CORR-ECT REPRESENTATION OF INFOR_MATION IN OUR FIl.ES IN ACCORD WITH SECTION 742 P I 80 E TAX ACT OF 1961. SIGNA'T"UREOF F\~ANCIA h) ~'v\~l\h. :-- DATE .---- : :UO .....In..... '1 j.lo'" oN '(p.PPD'I.Dqdlli) .,'10!Et) ..DlloP pe'pun~ "'~I pe.... .OU ..op ~'Np to -II .'11 ID lI'Odep .'11 ..~.. lunO..D ~.n. OJ 1"011.. 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