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HomeMy WebLinkAbout09-12-78 R CC-42 (4-77) BAN; NO. COMMONWEALTH Of PENNSYLVANIA 07-2ilr,.,6 OEPARTME NT Of REVENUE DATE FILED NOTICE OF DECEDENT ACCOUNT STATUS 'J/12tr!\ Submit in truplicote within TlIdoys olter knowledge 01 STATUS OF ACCOUHfj ~: (JOINT, TRUST. OR INVESTMENT the death. r!l . , UAO 'J/3/75 RETURN COMPL ETED NAMES ON ACCOUNT SOCIAL SECURITY NUMBER(S) FORMS TO LOCAL COUNTY '!;rv A. ~J'\enl< 2-)7 -310-7220 INHERITANCE TAX OFFICE SURVIVING DEPOSITOR (Benefldary) INFORMATION OECEOENTINFORMATION NAME RELATIONSHIP NAME DATE OF DEATH TO DECEDENT. Mary A. She. ,- ~ ADDRESS ADORES:) R. .. Ill. c/o l"Mlno1. L Shenk . CITYMel/lh n1 COUNTY .-" . . It cebUl'lll ZIP CODE 17MS BANK/INSTITUTION ADDRESS BALANCE OF ACCOUNT AT 000 $ . . :>, " INTEREST ACCRUED AND COLLECTIBLE AT 000 $ 'l'hll1"1l"f!t l\.n\c " ':'rust Co. TOTAL $ /()'1'1 '0,"'-- !"a1n .~ '.I~l"ket ~t.II. BANK AUTHORIZATION MeohrmlolWburv. !'A 110SS I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A ., CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD WITH SECTION 742 P I 8: E TAX ACT OF 1961. ~~~~Z"n~ATO~. DATE ~ :.r;!l'-'v'C-: \.. ,111~ .---t Q-IY-7& .~IIDnp!A!pu! Juapa""p a'lJ ~q Pla~ OJunD>>Y (E OO.O~$ ,apun a,uDIDq D ~HM OJunO>>D JU!Or Il: .OJunO>>D allM pUD puoqonH (1 :uo p.:u!nbe.l S! ~oda.. oN .s8!,Jod p..!.... PUD al!M pUD pUDqon~ ~q Pla~ oJuno>>y (S .~J'''f 00 pUD 'sJuno::)::)o "'Dl(S '-usodep fO ,aID:) !j!J.l8:J so "I3ns 'Sluno:):)o JU8WI'8AU! -IU!Or (Jr' s lun03::t'f IS nJ 1 (E oJuno>>y 6u!~'a~::> JU!Or (Z slun033.., s6u!^OS IUlor (L :uo p...!nb... s! ~odaJ V .(pappD o,oDQdW3) ...(O~$) SJDlloP pa'pun~ aa'~J paa,xa JOU oaop ~JDap 10 aWH a~J 10 Hsodap 8'11 uaqM 4un0330 &f3ns 0", p.lo6a.r U! p~U!nb8" aq HO'ls UOHD:J!HIoOU ON ....unO:)30 a..... 0'" SJO^tAlns 10 JO^!A.lns alp fO ssaJppo PUD awau 8'11 PUD UOH"I!"'su! ID!:)UDUIJ 8L11 LlIlM. '1I08p fa "IDp aq... 10 I!!oelap UO olD pa,JS8AU! lunOWD 8'11 '.Juauq.S8AU! .10 Hsodap ISnJ.. 10 IU!ol 8'101 fO UO'4D8..:) .~ fa ....op 8'11 'uos..8d paSDa:J8p 8lfl fO "WDU 8'11 6u!^!6 joa"8'11 anuaAaH 10 JuawJ'Ddaa a~J ~HoU OJ ~JDap a'lJ 10 a6palMou~ .l8.ijO s,(op (Ol) u.... U!'1,IV^ UO!ln.j.!ISU! ID!:)UDUlJ 8'i-1- fa .4np 8'11 -'I 110'1' ..., 'alP !lOllS IO.Wlt.AU! olD I!Sodap aLl'" 0'" S8!.f.IDd 8'11 fO 8UO PUD '''BIfID.lO .Ia'iJOUD .I0j Jsn.lJ U! suos.lad.lo uos.laa D jO aWDU aqJ U! .10 Qj!M PUD puoqsn'i UD't4 .Ia'iJo SUOS.lad 8.10W .10 011\.Io jO saWDU alfl' U! O!UDAI.(suuad U! PQ.(.O:)OI uo!.(.n.(.",SU! ID!3UOU!j D U! pa.(.S8AU!.I0 paHsodap 5! .(auow uaqM.u .1961:10.L::>Y XY.L 31'1"1$3 aNY 3::>NY1IUHNI 3H1 :10 ZI'L NOI1::>3S