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COMMONWEALTH OF PEffNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PA.
17127
MAY 22 1978
RCC.43 (4-~1
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
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Pa. Ave. & Landvale St.
York Hven, Pa_ 17370
ZIP CODE
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building,3rd, Floor
411 S. Second Street
Horri sburg, Pennsylvanio 17127
Pursuant to Section 742, -Pennsylvania"lnheritance and Estate Tax Act of 1961, we
herewith submit the following report:
ACCOUNT NO. OF JOINT. TRUST OR
INVESTMENT DEPOSIT C. ofD. #s 100-6145, 8440,'& 9181
NAMES ON ACCOUNT OR
INVESTMENT
Amos B. Sweioart or Esther L Harris
DATE OF DEATH
May 18, 1978
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR Amos B. Sweigart
ADDRESS
420 4th St.
New Cumberland. Pa.
~t/
]7070
COUNTY
ZIP CODE
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
Ruth 1. Harris
ADDRESS
same
RELATIONSHIP TO DECEDENT
Daughter
DATE INVESTMENT WAS ESTABLISHED
WITH THE SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
C.of D.#6145 - 6/25/74 dated
#"8440 - 9/30/76 (ren. from 5693 3/aoI74)
#9181 - 11/1/77 (ren. from 7616 5fl/75)
BALANCE,INCLUDINGINTEREST C. ofD.#6145 - $5,325.75
PAYABLE, AT DATE OF DEATH $ #'e44Q - )5.2~e 47
9181 - $ 5, 196 . 64
AMOUNT OF PENALTY, IF ANY, FOR
RETIREMENT OF SAVINGS CERTIFICATE
OR CERTIFICATE OF DEPOSIT ON DATE
OF DEATH
none
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Cashier
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