HomeMy WebLinkAbout08-01-78
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RC C~72 (0...61:\1
.
APPLlCA TlON FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Bonking Association located in Pennsylvania:
DA TE Aug. 1, 1978
(a) (b) 4 shares Dauphin ]lep. Trust Co. (c) Common
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stack ar the face amount of
registered bonds, in (b), the name af the issuing company and in (c) the class of stock or the stated interest rate
and maturity date af registered bonds.)
3:!d:g~ 19:~27$2
ISSUED ON , and having a TOTAL MARKET V A>LUE OF $
(Date)
as of the date of death of the decedent,
128.00
Samuel J. Burkholder
, on
May 29. 78
(Date of death)
(Name of Decedent)
who was late of
West Pennsboro Twp.
(Street and Number)
Bo~__RD4~Newville
(Post Office)
Cumberland
(County)
PA
(State)
The securities are registered as follows: Samuel J. Burkholder and Rena L. Burkholder Jt. Ten.
(Nome or names in which certificates are registered)
ADMINISTRA TOR)
EXECUTOR )
(Name)
NAME OF APPLICANT
(Address)
Rena L. BuPkholde.
COUNTY FILE NUMBER 21-78-415 ADDRESS OF APPLICANT Box 96, R.D.14, .ellVille, Plti,
BUREAU FILE NUMBER SIGNATURE OF APPLICANT ~.'i: ~-~#..et.J
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
CONSE~T TO TR~NSFER SECURITIES DATE~ '1, If ")V
I hereby consent to the transfer of the above securities now registered in the name of the afores~d
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 mode 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~=-C ClJ,~~
ReGISTER OF WILLS '1
Cu.,lGERliIi'li:! \l\!lBlilJ:
(Title) (County)
RC C.72:9,6'3)
. .
APPLlCA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
i
J
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvanio
Corporation or a National Banking Association located in Pennsylvania:
DATE
Aug. l, 1978
(a) (b) 8 Rh::lT"ea - TTGT~lIlp.OXati on (c) Common
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount of
registered bonds, in (b), the nome of the issuing company and in (c) the class of stock or the stated interest rote
and maturity dote of registered bonds.)
ll-lO-71
ISSUED ON 6-26-62 , and having 0 TOTAL MARKET V A>LUE OF $ 164.00
(Date)
as of the dote of death of the decedent,
Samuel J. Burkholder
, on
May 29. 1978
(Date of death)
(Name of Decedent)
who was late of
West Pennsboro Twp.
Box 96 RD4-Newville
Cumberland
PA
(Street and Number)
(Post Office)
(County)
(State)
The securities are registered as follows: Samuel J. Burkhold~ and Rena L. Bllrkhol nel" .It. "'..n.
(Name or names in whj-ch certificates ore .registered)
ADMINISTRA TOR)
EXECUTOR )
(Name)
NAME OF APPLICANT
(Address)
II... L. Bul-kboldep
Box 96. ..D.14, .evdll..
Pa.
COUNTY FILE NUMBER 21-78...415
ADDRESS OF APPLICANT
BUREAU FILE NUMBER SIGNATURE OF APPL'lCANT ~ 'l!! ~o.J
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 Clu 9
- DA TE :f 7~ I 7F'
I hereby consent to the transfer of the above securities now registered in the nome of the afor aid
Decedent and waive the filing 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, 1919, P.L. 521,
os 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.
B
RiCH~ !l!PAllMItsllI.1
REGISTER OF WILLS
____----Cili\\B~ cou~ll .
(Title) (County)
C;CC~72 r"....~8;
.
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of 0 Pennsylvania
Corporation or 0 National Banking Association located in Pennsylvania:
DATE
Aug. 1, 1978
(a) (b)::>9 Ah::lT"PR - GAC _ (c) Preferred
(NOTE: In describing securities enter in (a), ab Ole, either the number of shores of stock or the face amount of
registered bonds, in (b), the nome of the issuing compa~y and in (c) the class of stock or the stated interest rote
and maturity dote of registered bonds.)
ISSUED ON 7-19-1967 , and having 0 TOTAL MARKET V A>LUE OF $
(Date)
os of the date of death of the decedent, Samuel J. Burkholder
(Name af Decedent)
725.00
, on May 29, 1978
(Date of death)
who was late of West Pennsboro Twp.
(Street and Number)
Box 96 RD4-Newville
(Past Office)
Cumberland
PA
(Caunty)
(State)
The securities ore registered as follows:
Samuel .J.- Burkholder and Rena L. Burkhol der J't. 'I'..n
(Nome or nomes in which certificates ore registered) .
ADMINISTRA TOR)
EXECUTOR )
(Name)
NAME OF APPLICANT
(Address)
Rena L. BuPkholdep
Box 96, R.D.I4, .8-.111_,
COUNTY FILE NUMBER 21-78-4.J,S
Pa.
ADDRESS OF APPLICANT
BUREAU FILE NUMBER SIGNATURE OF APPLlCANL ~~ ~Aj
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, :T WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES DATE~ 'Z 1'1'7(
I hereby consent to the transfer of the above securities now registered in the nome of the afo ;aid
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 Tronsfer the herein described property operates only in reference to the estate of the
above-named Decedent.
(Si!ll!O~A~f))1!. ANllERSlll!
REGISTER OF WII..I.S
CUMBERLAND COU1l1l' ,
(County)
(Title)