HomeMy WebLinkAbout11-27-78
RCC-72 (9-68'
COMMONWEALTH 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 a National Bonking Association located in Pennsylvania:
DATE
No. 27 1978
(a) 900 (b) c c u n Corpl!lration (c) eOllUDGn at:.aek
(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
01/21;/70
, and having a TOTAL MARKET V A!lUE OF $
..
11).350.00
(Date)
as of the date of death of the decedent,
Mildred J. R1..1noar
(Name of Decedent)
,on hUQ 14 1978
(Date of death)
who was late of 3526 Sept. Drive
(Street and Number)
Cup Hill
(Post Office)
CU\'lIberl.nd
(County)
Pe". .
(State)
The securities are registered as follows:
Mildred J. Ria.lnQer
(Name or names in which certificates are registered)
~J:N~f~
EXECUTOR )
~11aabet:.hYille. Penna 11023
(Address)
NAME OF APPLICANT K. I. Daniel
COUNTY FILE NUMBER dl-? 8 -. ~ 5V ADDRESS OF APPLICANT Eliz_~b~thvilla, Fa 1,7023
BUREAU FILE NUMBER SIGNATURE OF APPLlCA~f>9'/(/,)Z~:;/>'[,/
NOTICE: IF YOU FAil TO PROPERLY Fill IN ANY PORTION OF THIS'APPL.ICATION', IT WilL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
p:. I. Daniel
(Name)
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES . ~A ~
DATE~U' 'I. It I q?t
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.
Signed for the Secretary of Revenue
ByfJi{2td; ~_~IL'0~ d~
(Signatute) . . . _-;:/t \
':',",....;,
C_c.JfY
(Title)
(County)