HomeMy WebLinkAbout03-26-80
nl~
Pir'AlIGN FOR AND CONSENT
TRANSFER SECURITIES
k:":GISTERED IN THE NAME
OF A RESIDENT DECEDENT
____"_______ ..___ ______._~_______~L_
*\
({)HI>.
DATE
~ 26, 1980
CorpomtHJi: H Co i-
FilED IN TRIPLICATE)
" :",'!I, DEPARTMENT OF REVENUE:
" herehy ,node lor calsent to the transler 0/ the lollowing securities 01 a Pennsylvania
>,:f Son,king Association located in Pennsylvania:
fJ'PLl~AT!rL'i ,."
TO THE PEH,< !
(aL_ 4~
(NOTE: In .,'e"
reg!stE:.>red ; ,:,(()
and maL;"i!'; :j ':
PennsylyaI1illu~b:l:lad COllf:l811Y (c) CDm1:n
,,"D'" :;o,c',il'ies .,n;er in (a), abOle, either the number 01 shares 01 stock or the lace amount 01
"Ie (,Gr.'" .,/ ''1'' ,sclling company and in (c) the class of stack or the stated interest rate
i: r';:"~_:!',H'r,;~d bonh.)
~]S o~ ih.:: dote
June 25, 1964_, and I,oving 0 TOTAL MARKET VAtUE OF $
,0-;\
Iva M. Strohm
th'~' decedent, >.._.____._
61.25
ISSUED ON
,',if I;
, on
'Nc:lvelli:ler 18, 1977
(Namv of Decedent)
(Date of death)
".treef O;"'d NUMber)
(Post Office)
(County)
Pennsvl vania
(State)
who was lek .'; Shi~~~__Ehi~~
C\JIi:lerland,
Iva M. Strohm
The secor-!tl>'?S ;:n., r(.~q '~,'C!-f'd l1S follows:
Shippensbtu:g, FA 17257
- ----------------.--
(Address) .
NAME OF APPLICANT Hamiltxn C. 0!I.V1S, EsquiJ:e
24 west K1ng st.
COUNTY rk':: ;ijN,t'..l\ 21-78-94 __nADDRESS OF APPLlCANT_~' PA 17257 ~
BUREAU FILE NU,\i,BER ______ SIGNATURE OF APPLICANT' - ~ ('-.j) .
NOTICE: if YOU FAIL TO PROPERty FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CON;,IOERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION,
Earl G. strohm and
John A. Strohm
(Name or names in which certificates are registered)
~,
EX ecu TrY" S
(Namt.)
Cl'!,',Qi~WEAL TH OF PENNSYLVANIA -. DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
1 h"i~r,.,,-
DATE~ ;;"(, /1/1'7/
~'lp.~:-.enr to ti,t- tfcnsfer of the above securities now registered in the name of the aforesaid
Decedan\ ,md ""iv"., ii i ing 01 a certificate certilying to the payment 01 the transler inheritance tax to which
ih~ prop" i)' "I '''' Dree;"'"" is :nade subject pursuant to the provisions of the Act 01 June 20, 1919, P.L. 521,
os amended (' d ,',e j;,")! lune 15, 1961, P,L. 373, as amended. This is also in accordance with the provisions
of the Act of AN;~ ~1 lq71~;. P.L. 343.
Tids Ce,r,<',,>: :'OT"lJilsfer the herein described property operates only in reference to the estate of the
above.narned DN;e{Je~~
'*\
Signe
\." t,
By
for the Secretary 01 Revenue
-~V1\L A
_ f ,(\I""--~
\ "
ture) ~
- G-.~j~
t (Sign
,i~LJP.~\~) ,
'y [TIt oj (
.
-