HomeMy WebLinkAbout03-24-81
*'
APPLICATION TO
TRANSFER SECURITIES
FILE NUMBER:
COUNTY ,;( / - 1%-",j () /
REV-517 EX+ (2-80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
REVENUE
NOTE: THIS APPLICATION MUST BE FILED IN TRIPLICATE WITH THE REGISTER OF WILLS FOR THE
COUNTY IN WHICH THE DECEDENT RESIDED AT THE TIME OF DEATH.
Name of Decedent:
SI9HveL
(;. Eou-s (?
DATE 3-24-81
Date of Death:
Address of
Decedent:
~~ .;2~ ,97F
.3 0 3 /-/19 tt.JM e..J lP"" i?" 1<1 D
C/lHfJ JltL L. 119. ;70// {!uHj~,I:;LmvD
(CITY, BOROUGH) (STATE) (COUNTY) ./
DESCRIPTION OF SECURITIES:
roo
(NUMBER OF SHARES)
(C~~ C. .PVY1J:Mf}a6t~PA~ >
1. Stocks a.
b.
d.
e.
ilLjg ,(Jd
(DATE OF DEATH
TOTAL MARKET VALUE)
(DATE OF ISSUANCE)
2. Bonds a.
b.
c.
(FAC~ AMOU~2)
(INTEREST RATE)
(MATURITY DATE)
rl.
e.
f.
(NAME OF ISSUING COMPANY)
(DATE OF ISSUANCE)
(DATE OF DEATH
TOTAL MARKET VALUE)
The securities are registered as fOllOWS:' ~lYllAEJ- C;, Btll-tS-E" cf-- Sh\~\e "5, ~oV\.SG
(NAME OR NAMES IN WHICH CERTIFICATES ARE REG STEREO)
Name of Applicant:
Address of
Applicant:
~duJ AAX)$
1
-S,c.
(STATE)
'J/1677
't- 'S:!'f'I S
~Ad~
CONSENT TO TRANSFER SECURITIES
I hereby consent to the transfer of the above.securities and waive the filing of a certificate certifying to the
payment of the transfer Inheritance Tax.
9J;d/l/'LJ.$tf, J1Fj
(DATE) ..
~/11f (!~~j
EGISTER OF LLSl .