HomeMy WebLinkAbout03-19-79
RCC-72 (9-68)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYL \! ANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Associalion located in Pennsylvania:
DATE March 19, 1979
(a)~) (b) American Tel. & Tel. Co. (c) Common Capital 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 registered bonds.)
ISSUED ON t-1ay 17" 1968
(Date)
as of the' date of death of the decedent, Sara.h B. Crowe
, and having a TOTAL MARKET V AILUE OF $ 608.00
(Name of Decedent)
on July 26, 1978
,
(Date of death)
who was late of Wesley Driv~'~t Bethany Village, Mechanicsburg. Cumberland, Penna.
(Street and Number)
(Post Office)
(County)
(State)
The securities are registered as followl!frs. Sarah B. Crowe
(Name or names in which certificates are registered)
NAME OF APPLICANT
Mechanicsburg, Penna.
(Address)
Mary F" Burgoon
Bethany Village
Mechanicsbur Penna.
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EXECUTOR )
Mary F. Burgoon, Bethany Village,
(Name)
COUNTY FILE NUMBER;? 1-.t:7~- tt-'S'1 ADDRESS OF APPLICANT
BUREAU FILE NUMBER SIGNATURE OF APPLICANT
HOTICE: IF YOU FAIL TO PROPERLY FILL IH ANY PORTION OF THIS APPLlCATI , IT WILL HOT
COHSIDERED COMPLETE AHD WILL BE RETURHED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES -'\". _
DATE I net),. .?l~, I ~r;r
I hereby consent 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.
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