HomeMy WebLinkAbout95-0525
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- ~ MoM~ Dey Yaar
~~ ENtK ~~ ~A~E DE~~7SIT 80X I rn 3 rl'
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M~~S* P: , .~srCTEC EY R~ ef3~i_:A.,v_ ~,.t ~i;VANC.~,.. a r -. ~= .r•.r_ ..-~ ,~> d :Y ' ,~ =ATED AND RETURNED TO AbOYE ADDRESS.
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~` ."S ~:A~'~`" .3~e'; 3OCiAi 4RClaR~;`" t~.`tdMBEia DATE OF DEATH
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ADDRESS r?• =fNT - - ~--a ---~_r_
Street ~+.G c : City Siot• Iip Ct>d•
NAN4E ~+~$ :'; `SS Ql~tsERSON REQiJE3TtNG T E ~P'EPIiIVG OF "ME 941=E Dt?I*OSIT bt?
Name
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SiriN aro{«ts - ~ CitY Sta+~ Zip Ct>c .
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NAME 4ND d~i?aESS ~F Ciiv6YlSiA~ 1NSTITCJTipN VtffIERE THE SAFE DEPOSIT 80X tS LCSCATEG -_-.-_~ •
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Str~tr A4tf*~u City Stvr~ Zip Ct>d• -_
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TtTi.E OR NAMEif! U?igER WHICH 80X 15 RE¢1$Tt:RED
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^YES ~NU If ye s. Gate d wtgt - _ __ -
MWnth Dey Yaee
b. Name and adOrHi of pir4nn31 regreslMatirt(e~, if named in the •~iH;
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Str1•t Addroes
e. Name and addr~~~ of oflern•y, if any:
Name
City State Zip Cad.
Ciry
smr. zip cad.
itr~ft Adders City S1Ph Zip COtt• __
Nome - it
Str~~t Addre><E - _ ~ ------ Ciry State Zip Ct>d~
1 c- t{fy under penalty a# per(ury tttst the above r•eard is wrreet on;' :vmplefsa to the beef of my ko6wtedye anti belief.
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