HomeMy WebLinkAbout03-17-78
. RCC-72. (9-68)
COMMONWEALTH OF PENNSYLVANIA
- OEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA liON 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 made far cttlsent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Associalion located in Pennsylvania:
DATE
N}j!{J/t.
(a) One (b) Cumberland Valley Co-op (c) common
(NOTE: In describing securities enter in (a), ab Ole, either the number of shores of stock or the face amount of
registered bands, in (b). the name of the issuing company and in (c) the class of stack or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON 12/10/55
,and having a TOTAL MARKET VAtUE OF $10.00
(Date)
as of the date of death of the decedent, John Jacoby
(Name of Decedent)
, on
2/13/78
(Date of death)
who was I ate of
150 C street, Carlisle, Cumberland County, Penn.y1vania
-------
(Street and Number)
(Past Office)
(County)
(State)
The securities are registered as follows: John Jacoby _..
Mildred Pauline Jacob~~m"1'lSOo"t!s se~i,h e'a'f'r:fli'l'lie, ,epli,;,ed)
Robert Blaine Jacoby RD 4 Newville, Pa.
~ Richard J. Jacoby, S~9 \'1. f..outher St., Carlisle, Pa.
EXECUTOR S r (Nome) (Add,ess)
NAME OF APPLICANT i dud a lin
R card J.
COUNTY FILE NUMBER ~-"\i., \\\n ADDRESS OF APPLICANT .ame a
it-
'll
BUREAU FILE NUMBER SIGNATURE OF APPLICANT
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT W
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~
DATE 19
. ,
I hereby consent to the transfer of the above securities now registered in the name of the of resaid
/971'
Decedent ond waive 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 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.
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~
Signed for the Secretary of Revenue
B(kL4L~JI\'W~/~?1-~
~ (Signoture) J
(Title)
'-;'.,':',:~)OM
,I'.I.~ ---~".."--------,-
:".:'J;'JiY (County)
RCC~72 (9-68)
COI./MONWEAL TH OF PENNSYLVANIA
DEPARTMENT DF 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 for consent to the transfer of the fallowing securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DATE
3/17/78
(a) Two (b) Cumberland. Valley .Co-oP (c) preferred
(NOTE: In describing securities enter in (a), ab fNe, either the number of shares of stock or the face amount of
registered bonds, in (b), the name of the issuing company and in (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON
8/14/56
, and having a TOTAL MARKET V HUE OF $
20.00
(Date)
as of the dote of death of the decedent,
John Jacoby
, on
2/13/78
(Name of Decedent)
(Dote of death)
who was late of
150 C Street, Carlisle, Cumberland County, Pennsylvania
(Street ond Number)
(Post Office)
(County)
(State)
The securities are registered as follows:
John Jacoby and Robert B. Jacoby
'ld d li .(Nome <,',"""m~ I\l,,.hlch cJV,;f;"o\e, <,'e .e....e,ed)
M~ re pau ne JaCODY, ~~U ~ ~~'r ~ar~1S~e, ra.
Robert Blaine Jacoby, RD 4, Newville, Pa.
Richard J. Jacoby. 529 W. Louther St.. Carlisle. Pa.
(Nome) Mildrl:ad'Y!a'uline Jacoby
NAME OF APPLICANT
COUNTY FILE NUMBER Yc..\ - '\'{ - \ \ \S, ADDRESS OF APPLICANT
~l""HtJIq)
EXECUTOR S )
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~
DATE' . '2... '1
I hereby consent to the transfer of the above securities now registered in the name of the a resaid
'9'7%
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 alsa in accordance with the provisians
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.
'*"..
"-".' ,
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, - '1;
Signed for the Secretary of Revenue
/7 G I
B(' L:.... '.. t:. !\:Yl Ii 1:/"?,,,.~1/4:;'?71
(SI9ri(d~~.) , "J
~.. L.~j,HY
(Titl~f--------
(County)
Rcc.n (9~68)
COt,iMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA liON 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 made far crosent to the transfer of the fallowing securities of a Pennsylvania
Corporation or a National Banking Assacialian located in Pennsylvania:
DATE
3/17/78
(a) Three (b) CumberlanC! Valley Co-op (c) preferred
(NOTE: In describing securities enter in (a), ab CNe, either the number of shares of stock or the face amount of
registered bonds, in (b), the name of the issuing company and in (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON
12/10/55
, and having a TOTAL MARKET V A'LUE OF $
30.00
(Date)
as of the date of death of the decedent,
John Jacoby
, on
2/13/78
(Name of Decedent)
(Date of death)
who was late of
150 C Street, Carlisle, Cumberland county, Pennsylvania
(Street and Number)
(Post Office)
(County)
(State)
The securities are registered as follows: John Jacoby
Mildred Pauline Jaco-BV~e l~eret ;"Stfi~~t~f;.t!ln:'fHfl;et:'eila.
Robert Blaine Jacoby, RD 4, Newville, Pa.
Richard J. Jacob~. 529 W. Louther St., Carlisle, Pa.
(Name) (Address)
NAME OF APPLICANT Mildred Pauline Jacoby
!tul"....:L BlaIh.. Jca<;ul"y
COUNTY FILE NUMBER ~.,\~' \ \lo ADDRESS OF APPLlCAN~ich rd J. Jacoby
'J.-
BUREAU FILE NUMBER SIGNATURE OF APPLICANT
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT W
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
~
EXECUTORS )
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE
I hereby consent to the transfer of the above securities now registered in the name of the of
~n/
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.
.'.'..
.;';i:ll<I.
t.. t\
. Ph
Signed for the Secretary of Revenue
&;)({.Ao d )j" L, {\;~JJv~t,7j C?-'l1eM.
;,(Sigl;.a~}I';i1~ .....
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(Title) (County)