HomeMy WebLinkAbout07-10-78
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RCC-72 (g-6RJ
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
*'
COMMONWEALTH OF P<:NNSYLV/,NIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTf COLLECTIONS
DATE
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 Pennsylvania
Corporation or Cl Notional Banking Association located in Pennsylvania:
(a) 200 (b) 1WIUJ1VBD1& Pwer . L1abt 00. (c) 00- ·
(NOTE: In describing securities enter in (0), ab CNe, either the number of shores of stock or the face amount 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 date of registered bonds.)
ISSUED ON~. 34, 1S'14 , and having 0 TOT ALMARKET V AilUE OF $ 4,208.2&
(Dote) 1978
os of the dote of death of the decedent, G.4.. J. ....r~1lAlJ.v , on JuDe 18,
(Name of Decedent) (Date of death)
who was late of
142 lb:'th BI8t atz._, 0ar1:1J11e, n--brad, ~1'V11D1& 1"1013
(Street and Number)
(Post Offi ce)
(County)
(State)
The securities are registered as follows:
(Name or names in which certificates are registered)
~
EXECUTOR )
COUNTY FILE NUMBE~ 78 330
BUREAU FILE NUMBER SIGNATURE OF APPLICANT It\.L
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APP ICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE
I hereby consent to the transfer of the above securities naw registered in the name of th
Rr
Decedent and waive the fi ling of a certificate certifying ta 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 provisians
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.
(Title)
(County)
Farmers Trust Company hereby acknowledges that funds are available for
payment of all taxes in the estate of George Joseph Kennedy, and as
executor, does hereby quarantee the payment of said taxes
Farmers Trust Company
Executor of the estate of
George Joseph Kennedy
D-4~~~fkt~YT.O.