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COArnONWEALTH OF PENNSYLVANIA
Department of'Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
JUDe 1, 1978
(Date of Entry)
1. Name of decedent: !.bomas J. EdQT
2. Address of decedent:
130 W. Main st., Apt. 1, Mechanicsburg, h., 170SS
3. Date of' death:
June 1, 1978
4. Name and address of person who requested the opening of the box:
J o:rce Keister
5. Name and address of the financial institution where the safe deposit box is
located:
CODIDODWealth BatioD&l. BaDk, Mechanicsburg Office
6. Number of box:
825
7. Title under which box is registered:
Thoraaa J. Eddy
8. Was there a will in the box? (Yes or No) DO
9. If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of' attorney, if any:
And now this 1st day of JunA , 19 78 , I hereby
certify under penalty of perjury that the above record is correct and complete
to the best of my knowledge and belief'.
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~ Signature
....1r' R. 'RAaAM'r'8, Viae Preaitha"t
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