HomeMy WebLinkAbout05-08-78
COMk,dNWFAL TH OF PENNSYLVANIA
C':FAPTMENT OF REVENUE
i:WfH,\lJ (IF 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:
Application is hereby mode for consent to the transfer of the following securities of 0 Pennsylvania
Corporution or 0 Notional Bonking Assacialion located in Pennsylvania:
DATEb1C(;1 g 1'7'711
(a)~_ one~_(b) Southeast-pm Artifici",l nrr->."<ling rrv,!:",m"H"", (c) CoIlm:m
(NOTE: In describing securities enter in (0), ab CNe, either the number of shores of stock or the face amount of
,egistered bonds, in (b). the nome of the issuing company and in (c) the closs of stock or the stated interest rote
and moturity dote of registered bonds.)
ISSUED ON April 1, 1953
, and having a TOTAL MARKET V AilUE OF $ 5.00
(Date)
as of the dote of death of the decedent, Jolm E. Ocker
(Name of Decedent)
, on ,T~nn:lry 1 c. 1 <J'7:':'
(Date of death)
who was late of
n. D. ~:5
C.l,; ~ns1-'>11rJ
(Post Office)
Cumberland
(County)
p(:lTln~
(State)
(Street and Number)
The securities ore registered os follows:
John j . ()cker
(Name ar names in which certificates are registered)
~)
EXECUT~X =)
P.".fi5. Shir~!{bt]T'J. p<~ 17?t;7
(Address)
NAME OF APPLICANT [,\lei 11(" " ",",lpr
COUNTY FILE NUMBERZl-7fJ-73 ADDRESS OF APPLICANT F~.D. i'5. Shi'1];JCnsr"ur'V. P<\. 17257
, (' ,r II' I
BUREAU FILE NUMBER__., SIGNATURE OF APPLICANT., n (! /L '
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
Lucille ,T. Ijc,'<er
----
(Name)
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIESn.-.,f\ f/ /q'7 y"
DATE 111. r 0; 0
I hereby consent to the transfer of the above securities now registered in the nome of the aforesaid
Decedc.r.t and waive t~e filing of 0 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,
os amended und the Act of June 15, 1961, P.L. 373, os amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Tronsfer the herein described property operates only in reference to the estate of the
ahnve.named Decedent.
*~
S,i~ned}or the Secretory oCf,Revenue
By 7\/ (~J f . \/\'7 J V/h:>~'Y', If~ 1Jf,~"
(~'.n~~~OM
" i
(Tltl.)
,I ;HY
(County)