HomeMy WebLinkAbout04-20-78
RCC~':! (9~1581
CO"'MONWijAL TH OF PENNSYLVANIA
DEPARTMENT OF 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:
Application is hereby mode for consent to the transfer of the following securities of 0 Pennsylvanio
Corporotion or 0 Notional Bonking Association located in Pennsylvania: Ccmnm stock;
Certificate Nos. POS206
(0) 40 ~1",rP.~ (b) Wp.i 0; M"rkp.to;, Tn r (c) and N077S 8
(NOTE: In describing securities enter in (0), ab Ole, either the number of shores of stock or the face omount of
registered bonds, in (b), the nome of the issuing company and in (c) the closs of stock or the stated interest rote
and maturity dote of registered bonds.)
DATE April 20, 1978
ISSUED ON 12/22/71 and 10/6/67 and having 0 TOTAL MARKET VAtlUE OF $ 1,080.00
(Date)
os of the dote of deoth of the decedent Stephen J. Hribick
,
(Name of Decedent)
on February 23, 1978
,
(Date of death)
who was late of 420 East Simpson Street Me chani csburg
(Street and Number) (Post OHice)
Om1ber1and
Penna.
(County)
(State)
The securities ore registered os follows: Stephen J. Hribick
(Name or names In which certificates are registered)
Clinton Drive, Shanokin, Penna. 17872
(Address)
NAME OF APPLICANT Dr. Marie T. Burke
601 Newtawn Street Road
COUNTY FILE NUMBER 21.78.143 ADDRESS OF APPLICANT ~lIare. Penna 19~7~
BUREAU FILE NUMBER SIGNATURE OF APPLICANT . ;.L:~._-);, '4/.;(1
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.
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EXECUTOR )
Reverend J!!lles R. O'Brien
(Name)
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE~ !'~ "}J-
I hereby consent to the tronsfer of the above securities now registered in the nome of the foresaid
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 ond 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
obove-nomed Decedent.
~
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Signed for the Secretory of Revenue
BY~~~~O):)~ ~^1 ~~~
(TII'o)
y
(County)
',.
RCC-72 UHI,)
"'. " "-
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF 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:
Application is hereby made far consent to the transfer of the fallowing securities of a Pennsylyania
Corporation or a National Banking Association located in Pennsylvania: Canmrn stOP<' Certificate
!\lcs. LCO-13991 and
(a) 150 shares (b) Pennsylvania Pewer & Light Canpany (c) LC 30176
(NOTE: In describing securities enter in (a), ab Ole, 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.)
DATE April 20. 1978
ISSUED ON 8/1/74 and 11/19 /7~ and having a TOTAL MARKET V AILUE OF $ 3 .357.00
(Date)
as of the date of death of the decedent, Stephen J. Hribick
(t-lame of Decedent)
on February 23, 1978
,
(Date of death)
who was late of 420 East Simpsrn Street Mechanicsburg
(Street and t-lumber) (Post Office)
Clm1ber1and
Penna.
(County)
(State)
The securities are registered as follows: Stephen J. Hribi ck
(t-lame ar names in whl'ch certificates are registered)
~ Reverend Janes R. O'Brien Clinton Drive, Shanokin. Penna. 17872
EXECUTOR) (Nam.) (Add....l
NAME OF APPLICANT Dr. Marie T. Burke
-----gb 1 Newtcwn Street Road
COUNTY FILE NUMBER 21-78-143 ADDRESS OF APPLICANT Newtcwn s~:r Penna. 19073
BUREAU FILE NUMBER SIGNATURE OF APPLlCANT~<! ~.(.u:~~ '. '--)~{' 4"/.6'
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.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ?t I 1q:)
DATE fAI. L~ ~
I hereby consent to the transfer of the above securities now registered in the name of the foresaid
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 Tronsfer the herein described property operates only in reference to the estate of the
above-named Decedent.
*~
Signed for the Secretary of Revenue
(Tltl.)
,:1 E. ANDERSOI
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