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HomeMy WebLinkAbout06-30-78 "'. ,.. ''': RCC-U (40077' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE .,...... ,- . .-~~ \ . ~ .;;, BANK NO. DATE FILED Submit in trup icatewithin the death. ' 1 NOTICE OF DECEDENT ACCOUNT STATUS 1 STATUS-OF ACCOUNT NO: (JOINT. TRUST, OR INVESTMENT ,.- ' RETURN COMPLETED FORMS TO LOC AL COUNTY INHERITANCE TAX OFFICE NAME SURVIVING DEPOSITOR (Banallcla.,.) INFORMATION- RELATIONSHIP TO DECEDENT. ADDRESS ,. -f " i "',,, - J....;.,..- ,-- BANK/INSTITUTION ADDRESS '!'hl'Jri~f,t 3~w.& Trust c()~ciJ t1a.i n !..'!n~ket r:ta. Me()il:;nicGbur<l~r>A 170,5 il r".~'l,!) NAMES ON ACCOUNT 'l~C..~lfJ"'3 6/30/78 Jo~~,a cT,. R\jflP SOCIAL SECURITV NUMBE:R(S) DECEDENT INFORMATION NAME ~ -":-.J!io. 1 . of ADORE S ljl'\n" ......<-_,,,-'" "'''" UE)~.l''U'':WJv'U.jC'''''';~. ,f;~'" CITY 1tllllhnlitMilI\l!r.t BALANCE OF ACCOU~T AT 000 INTEREST ACCRUED AND COLLECTIBLE AT 000 TO_TAL DATE OF DEATH COUNTY'i;-~_"_ C:.'t"'1 ftW\d h....~,_l._ ...~~ ZIP CODE "" l~O\~~ $ ~~;.J'~ $ $ BANK AUTHORIZA TION I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A CORR'ECT REPRESENTATION OF INFOR,MATION IN OUR FILE:S IN ACCORD WITH SECTION 742 -P I & E TAX ACT OF 1961. 51 0 ~Cv ATOR" OA'lkh t ..... . .... .. .. :UO .....10.... '1 4Joda.I oN '(lMPpD '1Ioqdw3) ..'(0(1;$), ..DlloP ....pua~ ....~. ...nn .ou ..op ~."p to .WI. .... .D H.od.p .... UO~M .unO~~D ~~n. .. 1"011.. UI p..la.... .q IID~' uOI.D~Ij!"u oN '.uao~~D.." """I"'no '0 ,0AI",a. .... to ....ppD PUD ._u .... PUD UOI."I.'UI IDI~uDult .... ~HM .....p to ..., .... .D .I'odop uo.o .....eAUI .ua_D .... ....WJ.OAUI '0 H'od., ...... .0 .uloI .... to UOI._~ .... to ..Dp .... 'uo...d ......~.p .... to ..DU .~. lIUIAllI too..... .a"A.~ to ."W4JDcIoa .~. AtI.OU .. ."p .... to .lIp.IMou'! ....D dDp (01) UOJ ul~HM UOIJ"\J'UI 101~uDUlt .. to qnp .... .q ""'" H '.IP IID~' ."WJ..AUI .0 .I'oclop .... .. "HoIDd ."1'0 euo pua '....0.10 ".'fIOUD .IOf JI"" U! suos.aad .10 uo...... D to ...u .... UI .0 "1M PUD puoq"~ U.... .....0 1U0I.... .._ .0 _ to ._DU .. UI DIUDAIA,uu.d ul ....D~I uO\J"\J,ul IDlaDult D ul ......Aul .0 ....'.ocIop '1 Aou_ u.'IM.. 'AIIDap,AIPUI ......ap .... Aq P"~ ..uao~~v (t 00'0<<$ '.pua .~uDloq D ",IM ..uao~~D .ulor lI: '.~uaO~~D .JlM PUD puoq.nH (t ".I4JDd 1"1'" PUD .JlM PUD puoq.a~ Aq P"~ quao~~v IS ........ 01 PUD '..uao~~D .'D~' 'H'ocIop to '..~Ij!J<O~ 'D ~~a. ".Uno~~D .uoWJ.OAul .ulor t ...ao~~v ."'1 (t ...ao~~v lIul'!~.'O .Ulor lI: '''00>>'1 llIulAOS .Ulor (l '1961:101::1'1 XVl3l1VlS3I aH'f 31::1KY1IlJ3IHNI ..Hl :10 l'L NOll::1:1$ ,UO p"lab.. '1 4J0dD< V