HomeMy WebLinkAbout10-12-78
.
'"
.,_/..;f,
, ._ ~ 0'
". _ "',0'
- ". ,,.;.
"- .-'.-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
HARRISBURG
RCC-43 (4-59)
NOTE: TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Deportment of Revenue
Bureau of County Collections
26 S. 4th Street
Harrisburg, Pennsylvania
-:e;-1,f- tJ1J!0
rs@c,
Dear Sir:
Pursuont to Section 742, Pennsylvania Inheritonce and Estote Tax Act of 1961,
we herewith submit the following report:
NAME OF REPORTING
FINANCIAL INSTITUTION ce,m Lanl:, Ii .A.
ADDRESS 331 l3riJ.ge Street. 'lev Cumber13!l<L PA
ACCOUNT NO. OF JOINT,
TRUST OR INVESTMENT DEPOSIT Checking Account l!f;51.~5t;-7
NAMES ON ACCOUNT
OR INVESTMENT ,;dml ~1. :;"wconer or G. R. IleW'coraer or
Nancy A. lIevcomer
DECEASED JOINT DEPOSITOR,
TRUSTEE OR INVESTOR J.:dna. W. II"vconer
ADDRESS
AND COUNTY 337 16th Street, l.lev Cumb.,r1and, FA 17070 County -. CUlIlberland
DA TE OF DEATH Febru..ry e, 197iJ
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR G. R. :levcomer or :Iancy A. Ilevcomer
"""71
caur::l:vu
ADDRESS
Ur.lr.Ile..a
RELATIONSHIP TO DECEDENT
DATE DEPOSIT OR INVESTMENT
W AS EST ABLlSHED
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
CnlrR5<r.m.
Febr~ary 8. 1)(3
747.44
j"f"
/
//. /'/ ---- ._-~- Dei'OS! t O~erat1on6
F. G. Stey ,,/ p/7J 1. Coordinator
Signature; TITLE
/
October l? 1978