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HomeMy WebLinkAbout05-10-78 *' RCC-89 COMMONWEALTH OF PENNSYLVANIA Department of'Revenue ENTRY INTO SAFE DEPOSIT BOX TO REMOVE A WILL OR CEMETERY DEED .M,?~ 10, l078 (Date of' Entry) 1. Name of' decedent: ~ Je Lpnn8~~ uortzler 2. Address of' decedent: Polo C011tt :::fD ': Mpr'n:::mi ~Sbl]rg, PeY'.Jlp. 1'70SC; 3. Date of' death: M@y Q7 1978 4. Name and address of' person who requested the opening of the box: ~8mD~ N uP~t~lpr Pt. 1 Box 63 Kinzer, P~. 17535 5. Name and address of the f'inancial institution where the saf'e deposit box is located: Fi::st Bank 'illd Trust Co. I'1echcmicsblJre:, PenYlD-, 17055 6. Number of box: 1606 7. Title under which box is registered: T t) . Leonard hertz1er 8. Was there a will in the box? (Yes or No) Yes 3..nd 1\ifary B. Hert71er ( Dled J.CJ-"-'!,/) 9. If' yes, state date of' will, name and address of personal representative, if named in the will, and name and address of attorney, if any: ll-lQ-68 1,Jil1iam 1J Sund3jT l"lecheJ' icsbure:, Penna. And now this ] 0 day of j'vh17 certify under penalty of perjury that the above record to the best of my knowledge and belief. , 19 78 , I hereby is correct and complete .// // /<>/ ' -" (~-/~ '!;/('1,<,.;:-I/- //~';. c c" ",,! c' .{/ Sig ature /'1 j, ,\ [:C {/,' /Q.,<:?_ " - {, ,- Print Name and Title