HomeMy WebLinkAbout01-23-78
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INHERITANCE TAX DIVISION .1
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Pennsylvania Deportment of Revenue ~r ~I
Bureau of County Collections ~ _~
Goble Building, 3rd, Floor ~~
411 S. Secon d Street '
Harrisburg, Pennsylvania 17127 ~
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
R C C-43 (6-74)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
DlU'ftu.lI8P08rl' an. !ltUft
VIft IJI)KE PUll
I.IJIJIB. PA..
ZIP CODE 1'JQU
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we
herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT
t1-139f'
NAMES ON ACCOUNT OR
INVESTMENT
lft.'114.. I. ~ OJ' 1In. Gn... .. 1IcIO..,
laJ1UU7 ''It '971
DATE OF DEATH
DECREASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR
ADDRESS .. I. fNat 8\.
Vel '~....., h.
.,n..... ....,.
COUNTY
ZIP CODE
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
0,.. I. ~
ADDRESS
226 I. hoD It., v.._'..,.h". 1'&. 1'JD41
RELATIONSHIP TO DECEDENT ..bull aM vUe
o.-r1alll
''104'
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED .ruTbeI' 4. 1971
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $ 1."104.89
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