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RCC-S9
COMMONWEALTH OF PENNSYLVANIA
Department of Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
March 27.1978
(Date of Entry)
1. Name of decedent:
Mrs. Mary G. Shaffer
2. Address of decedent: 544 Walnut Street. Apt. 8, Lemoyne, Pa..
17043
3. Date of death:
March 26.1978
4. Name and address of person who requested the opening of the box: Mrs. Evelyn G.
Tress ler
30 Julia Street. Sunbury, Pa., 17801
5. Name and address of the financial institution where the safe deposit box is
located:
Commonwealth National Bank
10 S. Market Square. Harrisburg, Pa..
17108
6. Number of box:
35-A
7. Title under which box is registered:
Mrs. Mary G. Shaffer or Mrs. Evelyn G. Tressler
S. Was there a will in the box? (Yes or No) No
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 27 day of March
certify under penalty of perjury that the
to the best of my knowledge and belief.
, 19 78 , I hereby
above record is correct and complete
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Signature
E. Valeria Lantz Manager
Print Name and Title