HomeMy WebLinkAbout10-11-77
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COAiMONWEALTH OF PENNSYLVANIA
Department of Revenue
RCC-B9
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
Get 1\ , Iq"'n
(Da te of En try)
1.
Name of decedent:
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2.
Address 'of decedent: (l \ 2:,
Date of death: ~\.,.",hu...
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4.
Name and address of person who requested the
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opening of the box:
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5.
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Name and address of the financial institution where the safe deposit box is
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located:
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-6.~ Number-'of box:
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7.
Title under which box is regis tered: fv\;-s..
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B.
Was there a will in the box? (Yes or 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: 1:.:k.~o,d Ap'.I1l. 17'(1
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And now this II day of ' U('o\..oll..'-A..
certify under penalty' of perj ury that the above
to the best of my knowledge and belief.
, 19 '71 . I hereby
record is correct and complete
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Signa ture
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,Name and Title
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Print
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