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RCC-89
COIIMONWEALTH OF PENNSYLVANIA
Department of Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
December 27. 1977
(Date of Entry)
1.
Name of decedent:
Ql11r~ IiorpJ e
305 E. Simpson St., Mechanicsburg, Pa. 17055
2.
~'
Address:,of decedent:
"
3. Date of death:
December 24. 1977
4. Name and address of person who requested the opening of the box:
Clare B. Hopple, 305 E. Simpson St., Mechanicsburg, Pa. 17055
5. Name and address of the financial institution where the safe deposit box is'
located:
The FiTst Rank and Trust CompanY of Mechanicsburg, Pa.
G. Number of box: 5Th
7. Title under which box is registered:
mATe Hopp] e
8. Was there a will in the box? (Yes or No) Yes
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: n,.t:""p,. h, 197f>
Clare B. Hmpp1e. Executor. 305 E. Simpson st., Mechanicsburg, Pa.
~1
And now this 27th day of December
certify under penalty of perjury that the above
to t~~t of my knOWI~ge;and belief.
LJ~ .(j ~J2L-
,
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.Tesse T.. Startze1 Jr.. Vice President
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