HomeMy WebLinkAbout04-29-80
REV-5l7 (8-78)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF FIELO OPERA TIONS
APPLlCA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for Calsent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Associatian located in Pennsylvania:
DATE April 29. 1980
(a) 76 abana (b) CG ~..lth Kae10ul Iaak (c) CUT ""\
(NOTE: In describing securities enter in (a), ab Ofe, either the number of shares of stock or the face amount of
registered balds, in (b), the name of the issuing company and in (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON (a.. oth.r au.>, and having a TOTAL MARKET VAiLUE OF $ 2..527.00
(Date) 'a1l1 V .....r .1.. 24 197.
as of the date of death of the decedent, ., , on .
(Name of Decedent)
(Date of death)
who was late of
448 lIDZ'tb Coll... 8t~..t. CarU.al.. C....~lad. fA
(Street and Number)
(Post Offi ce)
(County)
(State)
The securities are registered as follows:
Paul W. lD"cler and Kart. M. Ill"....
(Name or names in whi'ch certificates are registered)
~) Kari. K. h"deZ'. 448 11. Coll... Ie.. Carlial.. PA 17013
EXECUTOR) (Name) WILLIAltd~ssHAuaoH P C
NAME OF APPLICANT 10 But iii. IC..at .
COUNTY FILE NUMBER 21-78-33' ADDRESS OF APPLICANT Carllole, fA 17~
BUREAU FILE NUMBER SIGNATURE OF APPLICANT (j)~ 4'4 ';w.
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.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATE C1f.A.~~n.)9~b
I hereby consent to the transfer of the obove securities now registered in the nome of the aforesaid
Decedent and waive the filing of a certificate certifying to 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 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.
Signed for the Secretary of Revenue
B,_Pau,L {1,gp'iJ
(Signature)
~'f-"J'4 ~r--~ ot LtlJL c u,~~4JIlM.L
Titl (County)
CD.'l'lnCAD RO.
1927
4413
13257
DAD OJ' tllUB
1/ 2/70
2/ 2/70
3/26/73
.o.~
37
1
3.