HomeMy WebLinkAbout09-06-79
Rcc-n (9-6S)
COMMONWEAL TH 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 PEN~SYLVANIA'DEPARTMENT OF REVENUE:
A~plicatian is hereby mode for consent to the transfer of the following securities of 0 Pennsylvania
Corporation or 0 National Bonking Associalion located in Pennsylvania: '
DA'rE
Sept. 6. 1979
(0) 80 (b) Carl1s1e ,Corp. (c) CQ.lIIIIlon
(NOTE: In describing securities enter in (0), ab CNe, either the number of shores of stock or the face amount of
registered bonds, in (b)" the nome of the issuing company and in (c) the closs of stock or the stated interest rote
and maturity date of 'registereil'bonds.) ,
, ',4/23/79; 3/20/72;, , "
ISSUED ON' 6/16177 '", ; ~nd having 0 TOTAL MARKET V AtUE OF $ ~872.50
(Date), ,
as of the dote of death of the dec'e'ci~nt, Emmett Shelley ,on Mareh 27, 1978
(Ngme of Decedent)
(Date of death)
who was .late 'of
34 South East St.. Carl1s1e, Cumberland, Pertna, 17013
(Stre~t .a':1d. Number)
, (Post OHi.ce)
(County)"
. "(State)
The securities' ,a~e;egistered, a.s follows:
. . . .
BlJ1lJlett Shelley ,
(Harne or nam-~s in which certificates are registered)
ADMINISTRATOR) ",
EXECUTOR )
George E. Hoffer, 9 Irvine Row, Oarlis1e, Pa. 17013
(Address) .
NAMEo'FAPPLlCANTGeorge E. Hoffel'
ADDRESS OF APPLICANT Car isle, Pa. 17013
(Name)
COUNTY FILE NUMBER21 18 188
.'
BUREAU FILE NUMBER' SIGNATURE OF APPLlCAN
NOTICE: IF YOU ,FAIL TO PROPERLY FILL INANY PORTION OF THIS AP I AT
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR CO
"COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
.' .",.", CONSENT TO TRANSFER SECURITIES 'DATE ,)\~rJV- 1_'0,7
I hereby consent to the tronsfer of the above securities now registered in the nome of th~ ~
Decedent and woive the filing of 0 certificate certifying to the payment of the transfer inheritance tox to which
the property of soid Decedent is mode subject pursuontto the provisions of the Act of June 20, 1919; P.L. 521,
os om ended and the Act of June 15, 1961, P.L. 373, os amended. This is olso 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.
Si gned for the Secretory of Revenue
B~~ (;~rl~
(Signature)
'iiiCHilRlloE?"liiIDmli'Dlll'
tll::11;~II::.r; u'(e;;~ )
('l'~l BERlAND l.o;J~fitir
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(Title)