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RCC-'72 (9-6~
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Applicaticln is hereby made for CQ1sent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
The Atlantic Refining Company
(a) 350 shares (b) Atlantic Richfield Company (c) CODIOft stock
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount of
registered bonds, in (b), the name of the issuing company and in (c) the class of stock or the stated interest rate
and maturity date of rf~gistered bonds.)
DA TE November
, 1978
ISSUED ON see at:taehed list: , and having a TOTAL MARKET VAILUE OF $ 17.412.50
(Dat'~ )
as of the date of death of the decedent, Gra~e B. Pogehange'r
(Name of Decedent)
, on
July 4, 1978
(Date of death)
who was late of 300 East Kinst Street. Shippensburg.
(Street and Number)
(Post Offj ce)
Cumberland County, Pennsylvania
(County) (State)
The securities are registered as follows: Grace 8. FOielsan&er
(Name or names in which certificates are registered)
~)
EXECUTOR )
Helen P. Coover,
(Name)
16 South Washington Street. Shippen.burg, Pennsylvania
(A r ss)
COUNTY FILE NUMBER :? /--'73"- Yt?3
NAME OF APPLICANT
te
,
NOTICE:
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REV
CONSENT TO TRANSFER SECURITIES 't1
DATE I\l t /9 ?g
I hereby conslmt to the transfer of the above securities now registered in the name of the aforesaid
Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as amended and the Act of June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer the herein described property operates only in reference to the estate of the
above-named Decedent.
Signed for the Secretary of Revenue
B~ ~W ~. Lt.,hw.-,. G'~' ~
(Signature) "
" ":,sml
'1"ilU.S
(Title)' Ct(;ibUnty)
CertificatEI No. 8D50149
AX15107S
AX21301
AOl683S4
for 115 shares Atlantic Richfield Co.
25 shares Atlantic Richfield Co.
15 shares Atlantic Richfield Co.
15 shares The Atlantic Refining Co.
ISSUED ON
September 13, 1916
December 1, 1911
July 16, 1968
January 21, 1959