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HomeMy WebLinkAbout09-12-78 , ." ~ " ----.. RCC.UC....77) BANK NO. COMMONWEALTH OF PENNSYLYANIA S02..ll~a..e OEPARTMENT OF REVENUE . D~TE- FILED NOTICE OF DECEDENT ACCOUNT STATUS fJ~I1B Submit in. truplicate within 10 do Y5 after knowledge of STATUS'OF ACCO'liftf1~H (JOINT, TRUS!. OR.IN.YESTMENT the death. , '>N.U U ". - Detore 19M > RETURN COMPL ETED NAMES ON ACCOUNT SOCIAL SECURITY NUMBER(S) > -17 IS. MIiJt 203..1o..?20.3 0- FORMS TO LOCAL COUNTY . INHERITANCE TAX OFFICE . . '.,., '. :'SURVIVING DEPOSITOA:(Beneflclary) INFORMATION DECEDENT INFORMATION .';,' .> NAME REL:.ATIONSHIP NAME DATE OF DEATH '1 TO DECEDENT. r'1li17, 1\. b/26/'IS . ;f/;Iy .. ADDRE~S . . ADDRESS . 221 s. t.fil8hi.ngtonSt. CITY ~TY laM . ~cl:ttmiC$bure ex' . ZIP CODE 1"'10:55 BAN.K/INSTlTUTlON ADDRESS BALANCE OF ACCOUNT AT 000 0 $ '1'l11!l Fim Stlnk e~ ""il5t de. INTEREST A.CCRUEO AND COLLECTIBLE AT 000 $ "..~. (I Nat1l.& 'Mtl1.'lfirt. StE. TQ_T.AL _ $ ~'i9el1t1l\1cllbtl1't:r~ PA 110~ , BAN K AUTHORIZA TION I HEREBY, CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS.A CORR'ECT REPRESENTATION_OF IN FOR,M-ATtON IN OURFIL.ES IN ACCORD WI,TH SECTION 742 PI 8: E TAX ACT OF 19tH. 5 ~_FIN ~nGAT~ /. I DATE ( -- .,p .V ~ .~, ~, c--er- Cj /I'-j 71? . . , ~. . :UO ....In.... '1 ,",odal oN '(p.ppO .,...qd"3) ,,'(oCES), ..01l0P pe'pun~ ...~~ pe.u. ~OU ..op ~oep fO "I~ .~ ~o H'odep .~ U.~M ~uno:>:>o ~~n. ~ pull.. UI ....In.... ." II~' UOI~D~lfl~u oN '~uno~~D.~ ~ """IoURI '0 ,0AI..n. .~ fO ....ppD PUD .....u .~ PUD UO~"'I~SUI IDlaDulf .~ ~IM ~oep fD .~op .~ ~D H....P UD'D pe~'DAUI ~un"D .~ '~UDuq'DAUI '0 ~I'odop ~.~ JO ~ulol .~ fO Uo,~_~ .~ fO .~Dp .~ 'uo...d pe'oe~.p .~ fO ."DU .~~ IIUIAIII f-"~ .n"'AD~ fO ~UD""'DdoO .~ Afl~ou '" ~oep .~ fO .IIpeIMDU'I "~D dDp (Oil ~ ul~~IM uOI~"'~'u, ID!~UDUIf .~ fO ~np .~ ... II~' H '.IP IID~' ~...uq'DAUI .0 H.oelap .~ ~ "~Dd ...~ fO .uo PUD ...~O '0 '.~OUD 'Of ~.~ UI .UOU.d.D uou.d D fO .....u .~ UI '0 DfIM PUD puoqsn~ UD~ ..~o suouDCI ..- ... _ fO ,_DU .~ UI DIU""IA,uu.d UI pe~D~1 UOI~"'I~'UI IDlaDulf D UI pe~"Aul .0 pe~I''''P '1 Aouow u.'lM.. 'AIIDnplAIPUI ~"'pe~p .~ All P"~ .~uno..y (E oo'QCE$ "pun .~uDloq D ~IM .~nO"D ~ulor II: '..unO~~D DfIM PUDpuoq.nH U ".I,",Dd "'I~ PUD DfIM puo puoq.n~ All P"~ .~uno~~y (S '~Of 01 PUD '.~nD~n "D~' .f1....p fD ..~mlf~~ 'D ~n. ..~Uno:>:>D ~......DAUI ~ul..,. 0- .~nD~~y 41".1 (E .~no~~y IIUI'I~DIQ ~ulor IZ ,~o"y IliUIA"S ~ulor II 'l96l ::10 .1:>y xn Uy.lS~ ONY ~:>NY .1IU HNI ~H.1 ::10 C:"l NOI.1:>~S :UO p..ln.... '1 ,",DdaI Y . .~ ,_..:..~~ . ""' RCC-42 (""77) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE NOTICE OF DECEDENT ACCOUNT STATUS RETURN COMPL ETED FORMS TO LOC AL COUNTY INH ERITANCE TAX OFFICE NAME SURVIVING DEPOSITOR (Beneficiary) INFORMATION RELATIONSHIP TO DECEDENT. ADDRESS o. BANK/INSTITUTION ADDRESS 'i'hQ ;-;'1'$1:. nt,~\t l?t~tCt.l. i'hil'l .e: th.t"r<ct -St.e. - l!{!!1hl1li1esburg, PA - 17Q$!) BANK NO. / "'( ~M..23)..e DATE FILED S!ATUS OF ACCOONT NO: (~OINT. TRUST" OR INVESTMENT 9/228 NAMES ON ACCOUNT R.;jt~r E. i'tay NAME Mn!'it E. p~r ADDRESS :.; .t.. SOCIAl. 5ECURlT~ NUMBER(S' 203-10"'203 OECEOENT INFORMAT N DATE OF DEATH 4/26/78 CITY ~1$. t.:Xiih4t~ r,t.. . , . !(oohanicsbtlr/:t - BALANCE OF ACCOUNT AT 000 INTEREST ACCRUED AND-COLLECTIBLE AT 000 TOJ-AL _ OU TY __ J'n -.. ~ ZIP COO'1'(O$$ $ $ $ ::l ~/. .3 ~= BANK AUTHORIZA TION I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS-A CORR'ECT REPRESENTATION_OF IN FORJ",rAi'tON IN OUR FILES IN ACCORD .WITH SEC.J,!ON 742 PI 8: E TAX ACT OF 1961. DATE 1//1/1 ? --:.-- ~ '(P8Ppo'lloqd"E1) .:(OlES). ..01l0P ....pun~ ...~. ....... .OU ..op ~...p to ."1' .~ .0 H'Oder .~ UD~M .uno..o ~.ftI .. p'''.' UI p"ln"" .q IIO~' U0f40'1f14OU oN '.unn.o.~.. uOAIA.ln. '0 .0AIA.ln. .'f1 to ....ppo puo .IUDU .'f1 puo UOI4Il1I,'UI 101.uoult .'f1 ~IM ~"p to .,op .~ ,0 'I'odop uo.o po,'.Aul ,unowo .~ .'.........ul .0 lI'odop ..u, ... ,Ulo! .~ to uOf4_' .~ to OIOp .~ 'uo...d po.....p .'f1 to ..,ou .~, lIUIAllI tOOM~ .n"uH to ,,,,,,,odoO .~, AtI40U .. 'fI"P .'f1 to .&peIMou'! MItO dop (Oil UDI ul~IIM uOIIftIIl,ul 101.uOUlt .'f1 to ~"P .~ oq 11'"1' 41 '.IP IIO~' ,UO",IOAUI .0 H'odop .~ .. IOII'0d DII' to .uo puo 'M'fIO '0 ..~ouo 'OJ ..u, ul .uou.d '0 uou.d o to .IUDU .'f1 U\ '0 .tlM puo puoqsn~ UO'fl M'fIO .UO.._ ..ow '0 ... to ._ou .'f1 ul O\UOAI.t,uu.d U\ pOIoool UOllftlf4'U\ 10lOUOUlt 0 ul ......Aul .0 pOI).odop ., .(oUOIU u.'lM.. '.tIlO"PIAlpU\ 'UD.....p .'f1 .tq P"~ ..uno..V IE OO'~ '.pun .,uoloq 0 ~IM .,uno..o .,ulor II: '.,uno..o OJIM puo puoquH U :UO ....In.... '1 ..... oN ".ll'od P'1'fI puo OJIM puo puoqln~ .tq P"~ qun....v (S '~OJ 01 puo '..uno..o ..o~. 'Hlodo, to ..,ooYP' .0 ~nl 'quno..o '.........UI ,uIOf' 0' .,uno..v ,I ~.1 IE .,un....v lIUI'!'OOO ,ulOr lI: ....no..v .lIUIA"S .ulor (l '1961:10 .L::lV XY.L UV.LSEI aNY E1::lKY.LIHElHNI E1H.L :10 tt'L NOI.L::lElS :uo '..In.....1 ..odo. V