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CO~!MONWEALTH OF PENNSYLVANIA
Department of Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
,
.1R"'" RT'Y "i0 I 197R
(Date of Entry)
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1.
Name of decedent:
.
Address of decedent:
-r<RY Woo H11r.r.P.T' 'f'\T'.
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29, 1978
Pa. 170'1'1
f~7~r"l3 . Date
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~~i,;..;t"i
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4~.~I-Name
of death:
January
and address of person who requested the opening of the box:
RRY Wo. Hutter Jr.. ,OS W. E1m\'lOod Ave., Mechanicsburg, Pa.
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5. Name and address of the financiai institution where the safe deposit box'is
located:
The First Bank and Trust Company
6. Number of box:
109-B
7. Title under which box is registered:
Ray E. Hutter
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: May 19, 1976
RAY Wo. Hllr.tP.T' ~T'., "iOS W. E1mwood A~e. Nechanicsburg, Pa. 17055
.
And now this 30th
certify under penalty of
to the best of my knowled
day of January
perjury that the
e and belief.
Jesse L. Startze1 Jr., Vice President
Print Name and Title
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