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RCC-89
COMMONWEALTH OF PENNSYLVANIA
Department of'Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
Ivle.y lC.?, 19'78
(Date of' Entry)
1. Name of decedent:
SUS3.n Ro Jones
2. Address of decedent:
R.D. #8, Cnrlisle, Pe. 17013
3. Date of death:
Mo.y 15, 1978
4. Name and address of person who requested the opening of the box:
Gr3.ce T. B:'0nizer, R.D. i;t8 Cerli:310, PD. 17013
5. Name and address of the f'inancial institution where the safe deposit box is
located:
10m t ('< lvf 1-, ., T1 l'-.}O c,..., C)
1st B'::n-::: ,,;: .1.rusJo., Lec.~8nJ_CSD'.lr3, .C'. .'
6. Number of box:
J'708
7. Title under which box is registered:
0.11 S~Y1 P n .Tono s
8. Was there a will in the box? (Yes or No) Yes
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: ;\.UZ.. ")i~_, 1973
_D3Vid U. Jon,:;s, I"lo.ry JaDe> ,\lex'3nder, ~etty A. TIarry,
_ r:-T'cice L. Brenizer nnd B:3rry J. Jones, R. D. ':1-8, Co-r:>lisl0" Fa. 170J3
And now this 19th day of'
certif'y under penalty of perjury that the
to the best of' my knowledge and belief.
I':ay , 19 78 , I hereby
above record is correct and complete
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Signature
Doris A.. Gochen:.,l)I'
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