HomeMy WebLinkAbout11-24-80
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA TlON 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 COlsent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DA TE ~ (11 . L~ ~ /~ cP-/l
(a) 94 shares (b) Dauphin Deposit Carporaticn (c) ChlAlull
(NOTE: In describing securities enter in (a), ab CNe, 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 registered bonds.)
ISSUED ON May 23, 1978
, and having a TOTAL MARKET V A>LUE OF $ $ 3,008.00
(Date)
as of the date of death of the decedent, Grace B. Fo:1elsan:}er
(Name of Decedent)
, on July 4, 1978
(Date of death)
who was late of 300 East King street,
Shippensburg ,
O:mberlard ,
(Street and Number)
(Post Office)
(County)
Pennsylvania
(State)
The securities are registered as follows: Grace B. ~elsanger
(Name or names in which certificates are registered)
I^'~ ;,t A,; ;.~", -,S! ~ i : ~
Helen F. Coover, 16 Sooth Washington Stre@t:, Sh:ip~nRhqrg, PA, D257
EXECUTOR (Name) (Address)
NAME OF APP LI CANT Grace B. Fogelsangp.r F.R1-Ah"
16 South Washington Street
COUNTY FILE NUMBER 21-78-403 ADDRESS OF APPLICANT ShiRJel1sburg, Permsylvania
BUREAU FILE NUMBER SIGNATURE OF APPLICANT /Z/;&....,J ~ {?c'. Cl:J...;:.-U
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS AP~'I"A,~6f Bi!:'ace B.
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
Fogel-
saI'r;Jer
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE ~
CONSENT TO TRANSFER SECURITIES / . -'?1f/y:c:t/
DATE ~r,o< ~
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Decedent and wa i ve the fi ling of a certi fi cate certi fy i ng to the payment of the transfer i nheri tance tax to wh ich
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.
!d~d~
(County)
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