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(' 0 M'I () I; I' " l_ r i~;J ., r N r-' 5'( l V A N I A
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
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[IUllcHU '_'J'.Jh '; ",-1... ~ ;ONS
!Efl._ICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby ~1ade for consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DATE-ro'NJ..i\p,\ \\0, \'\Yi
-.1 '
(a) 108 shares(b) C(HfONWEALTH NATIONAL BANK (c) Capital
(NOTE: In describing securities enter in (a), ab Oie, 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 __{See other SiD) and having a TOTAL MARKET V A'LUE OF $
(Dote)
as of the date of death of the decedent, Mary Elizab@t:h HOtlllQA
(Name of Decedent)
3,710.88
, on July 28 t 1978
(Date of death)
who was late of--13J East pa.rk Street
(Street and Numbe,r)
Carli81@,
(Post Office)
CnJllhtar]al1d,
(County)
Pa.
(State)
The securities are registered os foil lows: Marion David Holmes and Mary Elizabeth Holmes
(Name or names in which certificates are registered)
~,"~Jr~) Marion->>J_Hol.lles, 137 East Park Street, Carlisl&, Pat ]7013
EXECUTOR) (Name) (Address)
NAME OF APPLICANT William F. MIIrtson t Attorney for
the Estate of Mary Elizabeth Holmes
COUNTY FiLE NUMBER~1-78-463 ADDRESS OF APPLICANT 10 E.~St. Carlis1e17M
BUREAU FILE NUMBER SIGNATURE OF APPLICANT [Q; ~1rf,.-Jf;, 3
NOTICE: IF fOU 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 & II
DA T '"Yt, ~
I hereby consent to the transfer of the above securities now registered in the name of t aforesaid
t9'?(
Decedeni and waive the fi ling of a certificate certifying to the payment of the transfer inheritance tax to which
the property of so'rJ 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
(?
...~. /?
(Title)
(County)
Certificate No. No. of Share. Date of I..ue
970 53 January 2, 1970
553.5 1 March 2, 1970
S 1626 54 March 26, 1973
-
108
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C:CI'iI;H~,," Tf-; (jf
!,-,j S~' L \, A;---j I A
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
C l: P ", ~ .f"!-l ~7 ~j -~- r ;,.: I ~
BUf'E"l) ;., ':':0,;'; i '-;..'U..!:C 'iONS
APPLICATION (MUST BE FILED ilN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby mode for consent to the transfer of the following securities of a Pennsylvania
Corporation or a Notional Banking Associal ion located in Pennsylvania:
DATE .1aVl<t,li 1.1 \/", n -1'/
(a) 240 shares (b) FARMERS _ TRUST CClfPANY (c) capital
(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.!!.ee_other_ side}, and having a TOTAL MARKET VAILUE OF $
(Date)
os of lhe dote of death of the decedent, MARY ~LlZABETH HOLMES
(Name of Decedent)
7,920.00
, on July 28, 1978
(Date of death)
who was late of 137 East Park Street
Carlisle
Cumberland
(Street and Number)
(Post Office)
(County)
Pa.
(State)
The securities are registered os follows: MARION DAVID HOLMES and MARY ELIZABETH HOLMES
(Name or names in which certificates are registered)
A'DMtl'tt5.,.~.,tmt___!oIARIO~ D._~O~S, 137 East Park Street, Carlisle, Pa. 17013
EXECUTOR) (Name) (Address)
NAME OF APPLICANT William F. Hartson, Attorney for
tHe Estate of Mary Elizabeth Holmes
COUNTY FILE I~UMBER 21-78-463 ADDRESS OF APPLICANT lO~h S~rli81e17G!3
BUREAU FILE NUMBER SIGNATURE OF APPLICANT W_ 1/~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 SECURITI ES DA T~')'!' 16, '9') ~
! hereby consent to the transfer of the above securities now registered in the name of t e aforesaid
Decedent and waive the fj I ing of 0 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 Jnd 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 thl~ herein described property operates only in reference to the estate of the
above-named Decedent.
Signed fo~ the Secretar~f Revenue
B~1.a'7-J. E: L/\;\rJ~~ &h. 00n\
. . (~III."at~~,;~ \1
(Title)
(County)
Certificate No. No. of Share. Date ot I...ue
1620 20 October 23. 1959
2173 20 April 15. 1966
372S 40 October 1. 1970
5259 160 November 1S. 1973
240
REV-517 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
,.....,/ /-, (/ / /f'. -0)
0( - I(f- IJ-:" 1)
APPLlCA TION FOR AND CONSEN ~./
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 consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DATE ~~.;(~.J;~I
(a) 60 sbare- (b) ATLANTIC RICHFIELD COMPANY (c) Commnn
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount of
registered b'onds, 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 June 30,1980
(Date)
as of the date of death of the decedent,
, and having a TOTAL MARKET VAILUE OF $ 2.973.75
(Name of Decedent)
, on July 28, 1978
(Date of death)
MARY ELIZABETH HOLMES
who was late of
137 East Park Street,
(Street and Number)
Carlisle
Cumberland
PA
(Post Office)
(County)
(State)
The securities are registered as follows: Marion David Holmes and Mary Elizabeth Holmes,
(Name or names in which certificates are registered) JT TENWIlOS
Marion D. Holmes, 137 East Park Street, Carlisle, PA 17013
(Name) (Address)
NAME OF APPLICANT William F. Martson. Attorney for
Estate of Mary Elizabeth olmes
COUNTY FILE NUMBER 21-78-463 ADDRESS OF APPLICANT ar isl A
ADMINISTRA TOR)
EXECUTOR )
BUREAU FILE NUMBER SIGNA TURE OF APPLICANT
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WIL[ NOT B
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES DATE dd. ~~ /f'rl
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Decedent and waive the fi ling 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.