HomeMy WebLinkAbout06-06-79
RCC-n (9-66)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLlCA TlON FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPLlCA TION (MUST BE FILED IN TRIPf1cll€)462 DA TE ..Jo". S. 1919
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 Banking Association located in Pennsylvania:
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(a) 51 sh. (b) P... Woolworth (c) c.....
(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 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 Vv..[(......dW",- , and having a TOTAL MARKET VA1lUE OF $ 16S.'1
(Date)
as of the date of death of the decedent, Bertha P. Moni,han , on July 26.' 117.
(Name of Decedent) (Date ofd\!tutt)
who was late of Six Lints Court. RD , 5. MechaniC.bur,. eDberlaDel. PA1:70 55
(Street and Number)
(Post Office)
(County)
(St~te )
The securities are registered as follows:
BERTHA F. MOHIGHAN
AlII
'EXECUTOR
I " ,t '0 .".. ~.
(Name or names in whl'ch certificates are registered)
)
21-71-462
COUNTY FILE NUMBER ADDRESS OF APPLICANT! W.
BUREAU FILE NUMBER 21-78-462 SIGNATURE OF APPLICANT
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS P CATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU OR OMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES DA TE ~ ~ -11
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
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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,
of the Act of April 9, 1929, P.L. 343.
as amended and the Act of June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
above-named Decedent.
This Consent to Transfer the herein described property operates only in reference to the estate of the
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(Signature)
'lJeRARiJ'l ARD~
' REGISTER' OF W1W
'.~UMaEIUAND ml.OOt
By
(Title)
(County)
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