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HomeMy WebLinkAboutOC1971-1153 - ESTATE OF ZOTOV,J_ RCC-134 (1-'59)'•'. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE aUREAU OF COUNty COLLECTIONS ,IN~IE~ltANC!:tAX DIVISION Oi=FICIAL NOTICE OF INHERITANCE TAX APP~AISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION 1-1use I Pa .15350 TO:George Zotov Box 97 Dote:Septenter 22,1971 County WASHINGTON County File No._ Bureau File No.Cz3 -2/-1/S'3 We have received noticxOO;X(l~jJx.lfo:b~.tmIKAt:XXXXXxxXY,XXXXXXXXXXXXXXxx.x.x..XXxx.xxxx:xxxxxxxxx OhSept.11,.-19...1I...,you Come into ownership of certain property tl>:!;~X!Y~u.~ttRm~ L~b~Jtk Transfer from Anna.Zotov,deceased (I.luse) Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable and the liability for the payment of the inheritonte tax due is imposed upon you,as transferee. The property on which tax is hereby assessed consists 'of:Jt •Held in the Pittsburgh National Bank Canonsburg Office,CarlOnsburg,Perulsylvanis..ln t.he names of Ma.:rtha Zotoy or ---llera .ZQtov or George ZotOY•.B.a1anceuas of date of death $12.775.<!l. appraised by the Commonw~alth,as of th~dote of death,at $12#775,07 1/4 %of this amount is taxable at the rate of 6 %, ORIGINAL ASSESSMENT AMENDED ASSESSMENT DATE OF ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE o If you pay the above amount within three (3)months of the dote of death of the decedent,or on or before Dec.'J I'.197)you may deduct a discount of 5%ofthe amount of tax due,or D This tax become delinquent,fifteen (15)months after the date of death ond,in addition to the tax,statutory interest at the rate of 6%of the tax per annum is 'also due as of *.~_ 19_._in the amount of *If the tax is not paid by the above dote additional interest is due at the rote of 6%per annum until paid TOTAL AMOUNT DUE.$ $3,193:17 _......_-------- $--------- $======== APPRAISED BY:...--;.,r!,'.~t.-t/,(~.(..(!e."" {Inheritance Tdx Appraiser) ASSESSED BY:RUSS~ll:MARI"O.,: (Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to:To insure proper credit to your accountro1/AJJ this Official Notice must accompany/J .J\~Iw\~ment.Mail or bring it to: f~t£/%07,60"-AGENT FOR THE COMrrlQNW~A~fM ,COURT HOV§g~/::'/7 7/WASHJNGT,ON.P£HNA-//0:_,r J§igJ ~/9"..i!//,f.:?t. 0", If you have already paid this tax to an executor,administrator,attorney or other personal represe'ntativE!of the decedent for forwarding to the Commonwealth,list below the dote paid,name and address of the person to whom you made payment,their oHidal title and the amount. Date Paid Nome and Address of Payee Official Title Amount Paid Under certain circumstances,if,after the dote of death of the decedent,you personally paid funeral expenses or other just debt$of the decedent,with funds derived from the property herein taxed,such amounts expended by you may qualify as deductions against the gross value of the property in the computation of tax due.If any such expenditures meet all of the three folIowing tests,it is recommended that you itemize the payme.nts below, execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow those which he determines to be proper.The tax will then be recomputed and you will receive an amended assessment of tax. THE THREE TESTS WHICH MUST BE MET ARE THAT: 1 -You were personally legally responsible for these debts,and 2-You actually paid these debts out of the account or property described above a~d can furnish proof of such payment,if required,and 3 -These same debts are not also claimed,for tax purposes,by an executor,administrator or other personal representative of the decedent handl ing the admin istration of the general estate of the decedent or any oth~r transferee. SCHEDULE OF DEBTS Date Paid Name of Payee Description of Obligation Amount Paid . . TOTAL $ (attach separate sheet if requ ired) COMMONWEALTH OF PENNSYLVANIA) SS: COUNTY Of ----:;..) I,hereby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,._,for which I was legally responsible and which I did payout of the property herein taxed.I further certifyI that t,)the best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF 19_ Signature of Taxpayer REPORT OF REGISTER OF WILLS I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I have allowed deductions listed above in the total amount of $--------0 Date of Approval:_ Register of Wills ,,~ RCC-134 (1-"69)' COMMO'NWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BU~EAU OF COUNTY COLLECTIONS ,INHERITANCE TAX DIVISION OFFICIAL.NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINiSTRATION TO:__.....;;Mar=...::.tha~...;;;Z;..;;.ot~o;;;...:¥~_ B ox.97 Muse,Pa,15350 Date:__-1S.ueii.jpt,.LlL§eWlmlWhs<.erI.......,j2iid!2..,.~1~97""'1""'--_ County _-:.\v.;;:.:A.::..SH:.:;D:::.~:.::G.=..TCN.:::.:...._ County File No._ Bureau File No,c.,J -'7/-1/S3 We havereceived notice m~~~xxxxXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX on Sept.11,19-7!,you came int.o ownership of certain property li!.K:~. ~roOCK~mOOImtOO:W~(9:~·Transfer fran Anna Zotov,deceased (Muse) Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable and the liability for the payment of the inheritance tax due is imposed upon you,as transferee. The property on which taxis hereby assessed consists of:.........:J...:t:...:.~H.::.:cl::.;d~P-=i:.:t-=t.::.sb.::.ur.:::...sg2.:h:.-..:.;N=a=tJ.=-·o:::na::=:;l=--B=ank::.=:_ Canonsburg,Office.Canonsburg.Pennsylvania.In the names of Martha Zotov or Vera Zotov or George Zotov.Balance ~s of date of death $J2.775.<n. appraised by the Commonweahh,as of the date of death,at $12,775.CQ 1/4.%of this amount is taxable at the rate of 6 % ORIGINAL ASSESSMENT AMENDED ASSESSMENT DATE OF ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT $--------- AMOUNT OF TAX DUE J91·6,3 o If you pay the above amounfwithin three (3)months .of the date of death of the decedent,or on.or . before Dec.1 J J 197J ,you may deduct a discount of 5%of the amount of tax due,or .__2.•.s.a._ o This tax became delinquent,fifteen (15)months after the date of death and,in addition to the tax,statutory interest at the rate of 6%of the tax per annum is also due as of * 19__in the amount of ---------- *If the taxis not paid by the above date additional interest is due at the rate of 6%per annum unti I paid TOTAL AMOUNT DUE $$=========== APPRAISED BY:_,.;.".,_ (Inheritance Tax Appraiser) ASSESSED BY:RIISSEll MARINO:. "...~] (Agent for the Commonweatfl',) INSTRUCTIONS TO TAXPAYERS IsaOl To insure proper credit to your account this Official Notice must accompany your payment.Mail or bring it to:11M~ AGENT FOR THE COMMONWEALTH COURT HOUSE WASHINGTON..PENNA. Make checks or money orders payable to: ~4/f.?o~~ 4 I;:/77/ K,z;/.#//f':<c;. ,I J, If you have already paid this tax to an executor,administrator,attorney or other personal repres~nfatlve of the decedent for forwarding to the Commonwealth,list below the date paid,nome and address of the person to whom you made pa.yment,their official title and the amount. Date Paid Name and Address of Payee Official Title Amount Paid Under certain circumstances,if,after the date of death of the decedent,you personall}'paid funeral expenses or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended by you may qualify as deductions against the gross value of the property in the computation of'tax due.If any such expenditures meet all of the three following tests,it is recommended that you itemize the payments below, execute the affidavit,and return this notice.'The Register of Wills will examine the debts claimed and allow those which he determines to be proper.The tax will then be recomputed and you will receive an amended assessment of tax."" THE THREE TESTS WHICH MUST BE MET ARE THAT: 1 -You were personally legally responsible for the~e debts,and 2-You actually paid these debts out of the account or property described above and can furnish proof of such payment,if required,and 3 -These same debts are not also claimed,for tax purposes,by an executor,administrator or other personal representative of the decedent handling the administration of the general estate of the decedent or any other transferee.. SCHEDULE OF DEBTS Date Paid Name of Payee Description of Obligation Amount Paid -- - -. TOTAL $ (attach separate sheet if requ ired) COMMONWEALTH OF PENNSYLVANIA) COUNTY OF:_ SS: I,hereby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,,for which I was legally responsible and which I did payout of the property herein taxed.I further certify,that to the best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF_________"___19__t \ ~.",'Signature of.Taxpayer REPORT OF REGISTER OF WILLS I,the undersigned,duly elected Regi~ter of Wills in and for the above ~ounty,do respectfully report that I have allowed deductions listed above in the total amount of $~ Date of Approval:_ Register of Wills .,,\.. Muse,Pa.1531'lr' OFFICIAL NOTICE OF INHERITANCE TAX APPRAISEMENT AND ASSESSMENT OF , ASSETS NOT SUBJECT TO ADMINISTRATION RCC-134 (1-'69)'",. COMMQNWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS •INHERITANCE TAX DIVISION TO:__V_e_r~a_Z_ot_o_v_>- _ Box o/'{' Date:•.,.September 22,1971 County ~__..:.:~J=a=sh:.:;m=·:.s;gt=O'l1=--_ County File No._ Bureau File No.&3 -7/-lIs3 ~e have received notice~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-on Sept.i1l.19~,you came into ownership of certain property' Jm:M:K:kl7.cr:Del~lIX=ibcb!~~JlbDDXd:eot.Transfer from Anna.Zotov,deceased (Muse) Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable and the liability for the payment of the inheritance tax due is imposed upon you,as transferee. The property on which tax is hereby assessed consists of:'Jt.Held in the Pittsburgh National Bank Canonsburg Office,Canonsburg,Pennsylvan:ia.In the names of'Martha.Zotov or Vera Zotov or George Zotov.Balance as of'date of death$12,775.C1l. appraised by the Commonwealth,as of the date of death,at $12,775.Cfl 1/4 '%of this amount is tax~ble at the rate of >6 "% ORIGINAL ASSESSMENT AMENDED ASSESSMENT DATE OF ASSESSMENT TAXABLE AMOUNT LESS:ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF'TAX DUE o If you pay the above amount within three (3)months of the date of death of the decedent,or,on or beforeDec•11,19 71 you may deduct a discount of 5%of the amount of tax due,or,' o This tax became delinquerrt,fifteen (15)months after the date of death and,in addition to the tax,statutory interest at the rate of 6%of the tax per annum is also due as of *-~- 19__in the amount of *If the tax is not paid by the above date additional interest is due at the rate of 6%per annum until paid TOTAL AM NT DUE $ $_=3L:,1::.:::9=~~.7!..7~~~_ --~------- $--------- $=============== APPRAISED BY:{£dL,,,t-C-<r-/,t./M./ ...(Inheritance Tax Appraiser) ..~,~ ASSESSED BY:RUSSELtMARINO._•.,II ...,-.l (Agent for the CommonweaTt~ INSTRUCTIONS TO TAXPAYERS Make ~hecks or money orders paYa~b:IJ AU -_.To insure proper credit.to your account-"L-~~.. -~r.':.this Official Notice must accompany .-_"'V'T r""""'V\.4I~ur payment.-Mail or bring it to: /)-AGENT FOR THE COMMONWEALTH - -~~~/cfc!-OS-COURl'HOUSE WASHINGTON"PENNA.15301 /(~/;:/9?/ ~,4{///,f';l,r .'".).,~If you have already paid this tax to an exeC/utor,administrator:attorney or other personal representative of the decedent for forwarding to the Commonwealth,list below the dote paid,name and address of the person to whom you made payment,their official title and the amount.' Date Paid Name and Address of Payee Official Title Amount Paid SS: Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended by you may qualify as deductions against the gross value of the property in the computation of tax due.If any such expenditures meet all of the three following tests,it is recommended that you itemize the'payments below, execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow those which he determines to be proper.The tax will then be recomputed and you will receive an amended assessment of tax. THE THREE TESTS WHICH MUST BE MET ARE THAT: 1 -You were personally legally responsible"for .these debts,and 2-You actually paid-these debts out of the account or property described'above and can furnish proof of such payment,if required,and 3 -These same debts are not also claimed,for tax purposes,by an executor,administrator or other personal representative of the decedent handling the administration of the general estate of the decedent or any other transferee. SCHEDULE OF DEBTS Date Paid Name of Payee Description of Obligation Amount Paid . - TOTAL $ (attach separate sheet if requ ired) COMMONWEALTH OF PENNSYLVANIA) COUNTY Of _ I,,he~eby certify that the foregoing is a just and true statement of funeral expenses and other debts of the decedent,,for which I was legally responsible and which I did payout of the property herein toxed.I further certify,that to the best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance tax purposes. SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19__. REPORT OF REGISTER OF WILLS Signature of Taxpayer I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I hove allowed deductions listed above in the total amount of $--------0 I· Date of Approval:_ Register of Wills }o"unn ?CC-2 ;1 -I.~~ nEPARTM~!T OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG.PENNA.17 127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ~~~.~~??"!.9.7i'!. NTY Washingtoncou . FILE NO.63.~71~1l53... Appraiser Anna Zotov eanonsburgWhereas,late of . in the County of ~~.~~.~:".:~~.C?.~Commonwealth of Pennsylvania,having died on the l.lt.b.day of Sept.ember 19 71,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,~~~~.~.~~.?,an appraiser duly appointed according to law, having been designated to make a fair and conscionable appraisement of the said estate,and to assess and fix the cash value of all annuities and life estates growing out of said estate,hereby file the following appraisement: In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration of any estate for Ufe or for years.the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. Unit AppraisementDe.crlptlon of Alset Values Mada for Inheritance Tax Purpo.e. Jt.Held in the Pittsburgh National Bank Canonsburg Office,Canonsburg $ Pennsylvania.In the names of Martha Zotof or Vera Zotov or George Zoto • Balance as of date of de.tlth $12.??I:"~07i 3;,19J.77 I I ...'TotalF'':',3,193>.77 ." n Having been duly sworn according to law,I do hereby certify that the above appraisement is made in con- formity with law on this ~?:r..c:i day of N<:>.~l:>.~:r.:19 7~. .................................?44...W.9.-.~h;i,p.gt.9.p ....~w3.t..13:J"gg~... W h ·t Olumller and Street)as l.ng on,rae................................................................................................................................,Penna. (Post Offlee) WASHINGTON......County RESIDENT .INHERITANCE TAX APPRAISEMENT Estate of Anna Zotov Deceased. Late of Canonsburg..;,........ Date of Death,September ll,1971 Appraisement Docket Vol..,. Page,"""..__....N o.__.(»~Zl.·.~g.5.J.......... Filed in Register's OfJice,__..__J9 .. Amount of tax due,$______.. DEPARTMENT OF REVENUE Received, Examined and Approved,.. Wrote abo.u t A ppra-isement,. Appeal ft-om Appraisement,. Entered and charged,..................__.. " " ", I-~---~----~~------~----------~---~--~~-~-~--'~---~---------~------ .J representing Pennsylvania Inheritance or Estate Tax due from the following estate: 63.59 $--------.114:1 $----------0 $---------- $--------." %Tax on $$----------1IIlI Estate Tax,Act of May 7,1927 2%Tax on $_ 1.059.896%Tax on $_ 15%Tax on $_ 15350MUSE,PENNSYLVANIA November 11.~971DateofPayment ---j ANNA IZOTOV a/k/a Name of Decedent ------------------4 63-71-1153 9-11-71FileNo.Date of Death ---4 From:GEORGE ZOTOV -Paying On Ind.Liab. 209 SYCAMORE STREETAddress --l WASHINGTONCounty ~ Remarks: MJR TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of __%from _ to _ 63.59 $--------0 $--------1iII $,--------·01 u00 ~[p [~@illUrnSEALTOTALAMOUNTPAID $,==6=0=.4=1===~ NOTE:This Triplicate Receipt to be retainecl for audit purposes.~ii {/..,/}- Received b~...)~-:5~~-~/.:-J.rVY...O NOTE:In accepting the transfer inheritance tax on future estates,prior to the death of the I;(e ' •J£(Signature)• , tenant or tenant for years,as evidenced by this receipt,it is understood that the Commonwealth shall----_,",;i ;j;'j \ not be precluded or prevented from hereafter assessing additional inheritance tax at the death of th'e--.·\.....('1/--..x...I.~[;'--j ',-'.J~ life tenant or tenant for years whenever it appears that such additional tax may be legally due and <::,'\(Till.e) collectible for any reason whatsoever.-,J ___~__~i#~.~~-..__I $---,,....--------n $---------$---------J.II %Tax on $$111 Estate Tax,Act of May 7,1927 3,193.77 6%Tax on $---------_$----------n 15%Tox on $$• 15350HUSE,PENNSYLVANIA ANNA ZOTOV a/k/aNameofDecedent --1 63-71-1153 9-11.11FileNo.Date of Death ---i November 17,1971DoteofPayment--'---1 ONE HUNDRED EIGHTY-TIl and 05/100 ---------------------.--------RECEIVED doliars representing Pennsylvania Inheritance or GEORGE ZOTOV -Paying On Ind.Liba.Estate Tax due from the following estate: From:---------------------,.----------------------------RIJ Box 97Address 2 %Tax on WASHINGTON County ---------------------i Remarks: MJR TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of __%from _ to _ $-------_.~ $--------M $---------" 182.05 $========:I~ NOTE:This Triplicate Receipt to be retained lor audit purposes. TOTAL AMOUNT PAID .......--...."(,))JL"/1/,(.' Received by'---)-<,.f'.Dr",«1/L,!"/,,,,/\",j"\ NOTE:In accepting the transfer inneritance tax an future estates,prior to the death of the lif.,e"'-../\,(Signatur~ tenant or tenant for years,as evidenced by this receipt,it is understood that the Commonwealth shall ,/•J)/ nat be precluded or prevented from hereafter assessing additional inheritance tax at the death of the ',·.l,j·i 1 ]\M '•VA life tenant or tenant for years whenever it appears that such additional tax may be legally due and .....,~(Titl') collectible for any reason whatsoever.'v I ,__c__•,'·~_'_'',_~,_~'~'__',_._.~J IBIXHlKlIKIXIIB1IXXJII ONE HUNDRED EIGHTY.TWO and 05/100 ------ RECEIVED doliars MATHA ZOTOV ..Paying On Ind.Liab.representing Pennsylvania Inheritance or From:.--E_st_a_te_T_ax_d_u_e_f_ro_m_t_h_e_f_o_lI_o_w_in_g_e_st_a_te_:1!I J BOX 97Address -i 2 %Tax on $------'-------$----------ill1l 63-71-1153 9-11-71FileNo.Date of Death --i 191.63 $---------. 3,193.77 6%Tax on $$----------1111 15%Tax on $_ 15350MUSE.PENNSYLVANIA $--------0 NO'9'ember 17.1971 Date of Payment ------------------i ANNA ZOTOV a/k/a Name of Decedent --1 %Tax on $$----------IID Estate Tax,Act of May 7,1927 WASHINGTON County -----------------------i TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of __%from ----'-_ to _ 191.63 $·---------0 9.58 $----------11I $,----------n 182.05 $========~ISEAL •0 NOTE:This Triplicate Receipt to be retained for audit purposes.". TOTAL AMOUNT PAID ~. (',.,).)/i ',I'oJ',,",/"IReceivedby·"-:"::':'I..A-6.x..J/...X-,vvVv'-'V NOTE:In accepting the transfer inheritance tax on future estates,prior to the death of the Pf;;'\'-o~'(Signatur tenant or tenant for years,as evidenced by this receipt,it is understood that the Commonwealth shall '.'.'.i oJ //J' nat be precluded or prevented from"hereafter assessing additional inheritance tax at the death of the ..::,'\.J\/~,V:.-:.'...t (...~YA life tenant or tenant for..years whenever it appears that such additional tax may be legally due and ¥\(Tit'f\l) collectible for any reason whatsoever,'_)I I -----~----------------------~----_.~~,....;.::.,.-=--:-.-.:....-- -:.-..-:....-~-_.--~-- - ------~-~--- ------.---- - - _..........- [ --........,..........-..- representing Pennsylvania Inheritance or Estate Tax due from the following estate:From:.--III BOX 97 15%Tax on $$• 9.58 191.63 $--------0 191.63 $---------'L:J $,---------H $--------.1f.I $-------- $---------" %Tax on $$II! Estate Tax,Act of May 7,1927 2%Tax on $_ TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of __%from _ to _ 9-11-71 15350 3»193.77 6%Tax on $_ 63 ...71...1153 MUSE;PENNSYLVANIA Date of Payment --------------------i Name of Decedent -----------------1 WASHINGTON File No.Date of Death ----1 November 17,1971 DX ANNA ZOTOV a/k/a Address -l County ----------------------1 L 182.05 TOTAL AMOUNT PAID$E A L NOTE:This Trip!icate Receipt,to be retained for audit purposes. $'========11II (/>--""R"~.i.,'."('''' Received by "._~,\.,V~j:.L,'I /l ,J ..ri·-~ NOTE:In accepting the transfer 'inheritance tax on future estates,prior to the death of the life""':-~(Si9nO LJ)i! tenant or tenant for years,as evidenced by this receipt,it is understood thot the Commonwealth sholl .....I I •,/\ not be precluded or prevented from.hereafter assessing additional inheritance tax at the death of the',\.:,,:/\"0.~j,'Ct::.../ life tenant or tenant for years when'ever it appears that such additional tax may be legally due and ':::'\(Title) collectible for any reason whatsoever..-..i '.. _7_"_-_~_·_.::__--~"-=---.~.,_-_-~-_._-_.._.~_-_-.......:_.~_ ·,.\ RC C-43 (5-65) COMMONWEALTH OF PENNSYLVANIAa~f,~Cf~I'f!£D DEPARTMENT OF REVENUEou,t,t'TY ifj,'Lt/J 0;- HARRISBURG 't,.,OLi.[C"t"'lJ,1Yr Sf?/1 J .", 18 PH '71 J NOTE:TO BE SUBMITTED IN TRIPLICATE ,. '(.. Pennsylvania Department of Revenue Bureau of County Collections 26 S.4th Street Harrisburg,Pennsylvania Dear Sir: Pursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION Pittsburgh National Bank ADDRESS 4 W.PIke Street,Canonsburg,Pa.15317 ACCOUNT NO.OF JOINT, TRUST OR INVESTMENT DEPOSIT 82-2018239----------_.....-..._-----NAMES ON ACCOUNT \OR INVESTMENT Anna zotov or Martha Zotov or Vera zotov or George zot.ov DECEASED JOINT DEPOSITOR, TRUSTEE OR INVESTOR __~A...n_n&liia~ZI.WQ....towVJ&.,.·_, ADDRESS __.....;B::;,;O::.:;x:.:......:9:....:7....f,--:,:M:.;::u::..se=...!.....,-:P:....:a:..:.~1:..::5.=.3.=.50=--_ DATE OF DEATH September 11.,1971 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Martha Zotov or Vera ZotQv or George Zotov ADDRESS B_O_X_97_,_M_u_s_e_,_Pa_._1_5_3_5_0 --- RELATIONSHIP TO DECEDENT Children --....;;..;.-------------------DATE DEPOSIT OR INVESTMENT '.':'WAS ESTABLISHED 9:..01/:...:2:..:.7J-1=66~·_ BALANCE,INCLUDING INTEREST ,DUE,AT DATE OF DEATH $----~---~_I_---r'-----..•.;,-....' TITLE sistant Manager RCC-144 (10-68) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION TO:The Register of Wi lis _W_8_s_b_i_n9_·_to_n__County ...". CERTIFICATION - NO ASSETS IN ESTATE Estate of Anna Zot:.ov . Date of Death 9..,;11-71 County File No.3'?-:1,;2 y-9' Bureau File No.63.71-1153 J On ,19__,I filed a petition for letters _ in the above estate for the sole purpose of This is to certify that there were never any assets,reportable for Pennsylvania Inheritance Tax purposes,in the estate of the decedent either at the date of death or subsequent thereto. I certify that the statements contained herein are true and correct,to the best of my knowledge and belief. Signa'o,.X )J~~ Receipt Acknow Ied ged ---,~~~~':i;;;&~--/.~~c...A~/4.;<:::: Mart.ha Zotov 80x97 Muse,Penna..15350 (PREPARE IN TRIPLICATE) DAUGflTBR (Date)~,