HomeMy WebLinkAbout10-27-78
RCC-72 !9-68)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA TION FOR AND CONSENT *
TO TRANSFER SECURITIES I :1:iO.
REGISTERED IN THE NAME J ! , 1\
OF A RESIDENT DECEDENT
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APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for coosentto the transfer of the fallowing securities of a Pennsylvania
Corporation or a National Banking Associalion located in Pennsylvania:
DATEO",toher 27. lq78
(a) 182 (b) ~UPHIN DEPOSIT TRUST COMPANY _~.(c) Commnn
(NOTE: In describing securities enter in (a), ab eNe, either the number of shares of stock or the face amount of
registered bands, 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 various dated
,and having a TOTAL MARKET VALUE OF $ 5,551.0.Q
(Date)
as of the date of death of the decedent, NORMAN F. SHUEY
(Name of Decedent)
,on pf!hrn..ry:> Ii.. 1 q78
(Date of death)
who was I ate of
630 North Front St.
(Street and Number)
JWorrn1eysbur~ I.emnynf!
(Post Office) (County)
Ppnn !=I.yl '1"" i "
(State)
17041
The securities are registered as follows:
NORMAN F. SHUEY
(Name or names in which certificates are registered)
~~!il:kWkQ&l
EXECUTQRIX )
F.STHF.R M. KF.ISTF.R Ii 12 1i- Prnn+- ,S+- , Wnrml "'YRhnrg, Pa 17043
(Name) (Address)-
NAME OF APPLICANT. MVTCRS, MVlJ:RS. FLOtIJE~ &0 .Tfl,{NSON
COUNTY FILE NUMBER '1-78-119 ADDRESS OF APPLICANT p ~
BUREAU FILE NUMBER SIGNATURE OF APPLlCANTJ:\~~ 7.
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPl1lOR1!IOtil, tr.W
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
7043
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,BS:II
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES (
,. DATE~:nil'l/ /1( /11J/
I hereby consent to the transfer of the above securities now registered in the name of the~aid
Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which
the property of soid Decedent is mode subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as om ended 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
Bt1\-~~4)( r: (;v.,J!1qh ~~
(Signature) '- r~ I"""
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