HomeMy WebLinkAbout10-02-78
Rcc-n (9-58)
'..;.r.
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
'*
I.
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for consent to the transfer of the following securities of a Pennsylvonia
Corporotion or 0 Notionol Bonking Associotion located in Pennsylvonio:
Mechanicsburg. Pennsylvania
(0) 1+8 (b) The ,First Bank and Trust Company of (c) capital stock
(NOTE: In describing securities enter in (a), ob Ole, either the number of shores of stock or the face omount of
registered bonds, in (b), the nome of the issuing company ond in (c) the class of stock or the stoted interest rate
ond moturity dote of registered bonds.)
March 6. 1956 -- ,1+0 shares; May 27. 1966 -- ,,8 shares '
ISSUED ON , , and hoving 0 TOTAL MARKET V AiLUE OF $ 1+,560.00
(Date)
as of the date of deoth of the decedent, Anna Mary Zinunennan
(Name of Decedent)
DATE October 2, 1978
, on December 13. 1977
(Date of death)
who was lote of 130 Gettysburg Pike , Mechanicsburg
Cumberland Pennsylvania
(Street and Number)
(Post Office)
(County)
(State)
The securities are registered os follows:
Anna Mary Zimmennan
(Name or names in which certificates are registered)
~~&%~) Ruth F. Hess. 130 Gettysburg Pike. Mechanicsburg. Pennsylvania 17055
EXECUTOR) , (Name) (Address)
NAME OF APPLICANT Richard C. Snelbaker, ESQ.. Attorney
for the Estate of Anna Mary . nnan. Deceased
COUNTY FILE NUMBER 21-78-7 ADDRESS OF APPLICANT 41+ anicsbur PA
BUREAU FILE NUMBER SIGNATURE OF APPLlCAN
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS AP ICATlON, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEP ARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES A!'I -I-. , "', ni>. - '
DATE~/r
I hereby consent to the transfer of the obove securities now registered in the name of the of ores aid
Decedent and waive the filing of a certificote certifying to the poyment of the tronsfer inheritonce tox to which
the property of said Decedent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as amended and the Act of June 15, 1961, P.L. 373, as 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
B~<:~, f'.Cwj,~~~
RlCn R..ISi,gnatur<>l,.1 .'lJ ""'''''
. 1.I\....rtnu~~
REGISTER OF WILlS '
CUMBERIANn ~mlN.'f.f, _
(Title) - - -oj (County)