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RCC-72 (9-681
CoiMONWEAL 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:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporation or 0 Notional Banking Associalion located in Pennsylvania:
DA TE November
J 1978
(a) 287 shares (b) Philadelphia Electric Company (c) COllllDOD stock
(NOTE: In describing securities enter in (a), ab Ole, either the number of shores of stock or the face amount of
registered bonds, in (b), the nome of the issuing company and in (c) the closs of stock or the stated interest rote
and maturity date of registered bonds.)
ISSUED ON see attached list, and having 0 TOTAL MARKET VAilUE OF $ 4.995.52
(Date)
os of the dote of death of the decedent,
(Name of Decedent)
, on July 4. 1978
(Dote of death)
Grace B. FORel.anger
who was late of 300 East King Street,
(Street and Number)
Shippensburg.
(Post Office)
Cumberland COWlty, Pennsylvania
(County)
(State)
The securities ore registered os follows:
Grace B. Fogelsanger
(Nome or names in which certificates are registered)
lDUK~
EXECUTOR )
Helen F. Coover-16 South Washington
(Nome)
Pennsylvania
NOTICE:
V i
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENllE
CONSENT TO TRANSFER SECURITIES '71 (;', ~ ~
DATE ~1/, 7r! 7,
I hereby consent to the transfer of the above securities now registered in the nome 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 mode subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
os amended and the Act of June 15, 1961, P.L. 373, os 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 Secretory of Revenue
[' Q'
By J
,~~
(Title)
, '1'
(County)
.
Certificate No. CO 651332
C94638
C 150238
C0521244
C0431864
for 13 shares
100 shar..
100 shares
37 shares
37 shares
issued on: October 23, 1967
October 8, 1959
April 25, 1961
April 25, 1961
October 8, 1959