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APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
COMMONWE;\,L TH OF PENNSYLVANIA
DEPARTMENT 0;= REVENUE
BUREAU OF COUNTY COLLECTIONS
DA TElY\a'1 25, 1'111
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for CQlsent to the transfer of the following securities of 0 Pennsylvania
Corporotion or 0 Notional Bonking Associal ion located in Pennsylvania:
(0) 239 (b) n.upbin Depoait Truat Coapany (c) CJl~ -:m Capital
(NOTE: In describing securities enter in (0), ab Ole, 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 rate
and maturity date of registered bonds.)
ISSUED O~See other_ aide) , and having 0 TOTAL MARKET V AilUE OF $
(Date)
os of the date of death of the decedent, Paul W. Snyder
(Name 01 Decedent)
7,648.00
on June 24, 1978
,
(Date 01 death)
who was late of 448 North Colleae Street, Carliale
CUllberland
Pa.
(Street and Number)
(Past Office)
(County)
(State)
The securi ties are registered as follows:
Paul W. Snyder
(Name or names in which certificates are registered)
MARIE M. SNYDER, 448 N.Colleae St., Carli.le, PA 17013
(Address)
NAME OF APPLlCANTWilli!t---li.PH;r'sneet
COUNTY FILE NUMBER 21-78-333 ADDRESS OF APPLICANT earli.le, PA 17013
BUREAU FILE NUMBER SIGNA TURE OF APPLICANT j));~, 07 ~d..
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.
~M~)
EXECUTOR )
(Name)
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES --t /;
DATE ,~iL"l "] f
! hereby consent to the transfer of the above securities now registered in the nome of the ore~fd
Decedent and waive the fi ling 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, 1919r P.L. 521,
os amended and 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
above-named Decedent.
\
By
(Title)
(County)
Date Certificate No. No. of Shares
-
12/08/64 14088 50
6/15/67 24540 95
2/07/69 27335 19
12/12/69 29934 SO
7/15/70 33098 24
10/20/72 444 77 1
TOTAL 239 Shares