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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 PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for Calsent to the transler of the following securities of 0 Pennsylvonio
Corporation or 0 Natianal Banking Assacialion located in Pennsylvania:
DATE Dec. 13, 1978
(a) 60 Shares (b) Atlantic Richfield Company (c) Common
(NOTE: In describing securities enter in (a), ab Ofe, either the number af shares af stack or the face amount of
registered bands, in (b), the name af the issuing campany and in (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
March 8, 1965, July 16, 1968 and
ISSUED ON Sept. 13, 1976 ,andhavingaTOTALMARKETVAILUEOF$ 2079.00
(Date)
as of the date of death of the decedent, Robert C. Fest, Jr.
(Name of Decedent)
on Feb. 11, 1978
,
(Date of death)
who was I ate of
Box 93,
Grantham,
Cumberland,
Pa.
(Street (Ind Number)
(Post Office)
(County)
(State)
The securities are registered as follows: Robert C. Fest, Jr. and Dorothy N. Fest, Jt. Tenants
(Name or names in whj"ch certificates are registered)
NAME OF APPLICANT
93, Grantham, Pa. 17027
(Address)
Dorothy Nolen Fest
xmtlfHmr.mm)
EXECUT~ RIX )
Dorethy Nolen Fest, Box
(Name)
COUNTY FILE NUMBER 21-78-177
ADDRESS OF APPLICANT
Box 93, Grantham, Pa. 17027
BUREAU FILE NUMBER 21-78-177 SIGNATURE OF APPLICANT
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLlCATIO ,IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
fONSENT TO TRANSFER SECURITIES DATE~ )S {q7r
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Decedent and waive the filing 01 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 01 the Act of June 20, 1919, P.L. 521,
as amended and the Act of June 15, 1961, P.L. 373, os 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
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REGISTER OF WILLS
CUMRFRI ANn t{1~I~I1t..
(Title) (Cou"nty)