HomeMy WebLinkAbout06-22-78
RCC-;t- (1-~8'n..
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 PENNSYLVANIA DEPARTMENT OF REVENUE:
Applicatian is hereby made far consent ta the iransfer of the following securities of 0 Pennsylvanio
Corporation or a Nationol Bonking Association located in Pennsylvania:
DATE ,Tnnp 77
1q7r.
(a) 304 (b) DAUPHIN DEPOSIT BANK & TRUST CO. (c) Common
(NOTE: . In describing securities enter in (a), ab Ole, .either the number of shares of stock or the foce omount of
registered bonds, in (b), the nome of the issuing company and in (c) the class of stock or the stoted interest rate
and maturity date of registered bonds.)
ISSUED ON various dates
,and having a TOTAL MARKET VAilUE OF $ 9,120.00
(Date)
as of the dote of deoth of the decedent,
ARCHIE F. BUR"
, on
January 8, 1978
(Name of Decedent)
(Date of death)
(Street and Number)
Lemoyne
(Post Office)
Archie P.. Burk
Cumberland
Pennsylvania
who "Ias lote of
613 Huwme1 Avenue
(County)
(State)
The securities ore registered os follows:
(Nome or names in whi'c;:h certificates. are registered)
~tS.'T~.AcT1lml
EXECUTQRIX )
OOROTHY ~cDm'mLL
(Name)
4705 Wnrth
Clearview Drive, Camp Hill, Fa.
(Add..,,) 17011
HYEHS, MYERS y FIJO~.mR & JO.':1~.JSON
NAME OF APPLICANT
COUNTY FILE NUMBER 21-78-28 ADDRESS OF APPLICANT P. O. Box 125, Lemoyne, Pa. 17043
BUREAU FILE NUMBER - SIGNA TURE OF APPLICANT by: ~ 1-
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLlCA Tla~wrf-W{d~ 1'ldTY~S
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE
I hereby consent to the transfer of the above securities now registered in the nome of th
Decedent and woive the filing of a certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is mode 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 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
obove-named Decedent.
*~
Si gned for the Secretory of Revenue
B~~A..~"1 E ~ d9f) D1T;), ~
RICH.lsr~1l"_\nJlJ'
REGISTER OF WIUS .
_ CUMBERlAND CDUNlt .
(Title) (County)
RCC.?f \,9-e;~'r-
APPLlCA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
COMMONWEALTH OF PENNSYLVANIA
DEPAIlTMENT OF IlEVENUE
BUREAU OF COUNTY COLLECTiONS
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made far consent to the transfer of the following securities of a Pennsylvania
Corporation or 0 National Banking Association located in Pennsylvania:
DATE June 22, 197!l
(a) 334 (b) CCNB Corporation (c) Common
(NOTE: In describing securities enter in (a), ob Ole, either the number of shares 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 rate
and maturity date of registered bonds.)
ISSUED ON Ja;\/Yvl'> ,and having a TOTAL MARKET VAtUE OF $ 4,008.00
(Date)
as of the date of death of the decedent,
{Nome of Decedent}
,on January 8, 1978
(Date of death)
ARCHIE F. BURK
who was late of 613 Hummel Avenue
(Street and Number)
Lemoyne
(Post Office)
Cumberland
Pennsylvania
(County)
(Stote)
The securities ore registered os fallows:
Archie F. Burk
(Name or names in which certificates are registered)
AQt.tlHfiHRitx&R)
EXECUT9RIX )
DOROTHY HcDOWELL
(Nome)
4750
North Clearview Dr., Camp Hill, Pa.
(Add,ess) 17011
IftERS7it MYERS, FLOWER & JOHNSON
NAME OF APPLICANT
COUNTY FILE NUMBER 21-78-28 ADDRESS OF APPLICANT P. O. Bo~ 125, Lemoyne,
BUREAU FILE NUMBER SIGNATURE OF APPLlCAN~Y: \l2~/J
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICA~NdW~ES
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
Pa. 17043
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~
. DA TE rl''7
I hereby consent to the transfer of the above securities now registered in the name of th a oreibid
{f(~ y
Decedent and waive the filing of 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 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.
Si gned for the Secretory of Revenue
B~u,.r.~Jo~
~AA!~:~~~J.i~"1 \I
~~~lm~NO; to\~1
u (Tlf1.f - . (County)