HomeMy WebLinkAbout05-22-79
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\2MMO":EAL T", OF PENNSYLVANIA
" t'EPARTMENT OF REVENUE
BUR EA~ 0 F COUNTY COL L ECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
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APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made far consent to tLe transfer of the fallowing securities of a Pennsylvania
Caraaratian or a National Banking Association located in Pennsylvania:
DATE May 22. 1979
(0\ 3 shares (b) BenQ-uet Consolidated Incorporated (c) Certificate No. N04SSfiR
: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 nome of the issuing company and in (c) the class of stock or the stated interest rate
and maturity dote of registered bonds.)
ISSUED ON 1/5/68
,and having a TOTAL MARKET VA>lUE OF $9.00
(Date)
os of the dote of death of the decedent,
Stephen J. Hribick
~Nam") of Decedent)
,on February 23, :978
~ Oo-e .,: de:,-'"
who was late of 420 East Simpson Street Mechanicsburg
Cumberland
Penna.
(Street and Number)
(Post Office)
(County)
(Stote)
The securities are registered os follows:
Stephen J. Hribick
(Name or names In which certificates are registered)
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EXECUTOR )
Clinton Avenue, Shamokin, Penna. 17872
(Address)
NAME OF APPLICANT Dr. Marie T. Burke
601 Newtown Street Road
COUNTY FILE NUMBER 21-78-143 ADDRESS OF APPLICANT ~wn sallar~enna. ~n
BUREAU FILE NUMBER SIGNATURE OF APPLICANT {_~_d..tJ/~, ~j RJllq/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.
Reverend James R. O'Brien
(Name)
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES /_ -t q _ lC
DATE ~ I
I hereby consent to the transfer of the above securities now registered in the nome of the aforesaid
Decedent and waive the 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 and 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 Transfer the herein described property operates only in reference to the estate of the
above-named Decedent.
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:~",d ,o,vtr1:2Dl
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(Signature)
JlICJ-lflim '- ANIIFP'::J,l(
REGISTER OF WILLS
~ CUlY.BEiU.A~ c.~'.JA1Y
~C'::-"2 ~S81
COMMONWEALTH OF PENNSYLVANIA
DEI''''RTMENT OF REVENUE
B~.EAU OF COUNTY COLLECTIONS
APPLlCA TION 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 consent to tlie transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DA TE May 22, 1979
(a) 100 shares (b) Family Security Life Insurance Company (c)Certificate No. 381
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount of
registered bonds, in (bl. the name of the issuing company and in (c) the class of stack or the stated interest rate
and maturity date of registered bands.)
ISSUED ON 10/15/62
,and having a TOTAL MARKET VAILUE OF $ Unknown
(Date)
as of the date of death of the decedent,
(Name of Decedent)
an February 23, 1978
,
(Date of death)
Stephen J. Hribick
who was late of 420 East Simpson Street Mechanicsburg
(Street and Number) (Post Office)
Cumberland
Penna.
(County)
(State)
The securities are registered as fallows:
Stephen J. Hribick
(Name or names in which certIficate. are registered)
~
EXECUTOR )
Clinton Avenue, Shamokin, Penna. 17872
(Address)
NAME OF APPLICANT Dr. Marie T. Burke
601 Newtown Street Road
COUNTY FILE NUMBER 21-78-143 ADDRESS OF APPLlCANTN~wn Sl.J1J:~ /
BUREAU FILE NUMBER SIGNATURE OF APPLlCANT)1'~ ~, ~~4/
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLlCA TION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
Reverend James R. O'Brien
(Name)
DATE {o-l4.- '1 Cf
I hereby consent to the transfer of the above securities now registered in the name of the of ores aid
COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
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.
\
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::ned for V~V~ C;
(Signature)
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