HomeMy WebLinkAbout11-16-81
REV-517 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
-
APPLlCA TlON FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPL/CA TlON (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the fol/owing securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DATENovember 16.1981
(a):>f!O sb.. (b) ATU..NTIC RICHFIELO COMPA\'t\lY (c) r.Onw'Qn"
(NOT: In descdbing secudties ente. in (a), ab "'e, either the numbe. af sha.es af stack a. the face amounl 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 Aprll 6., 1 qli9 , and having a TOTAL MARKET V AilUE OF $ 2,973. 75
(Dote)
as of the date of death of the decedent, Mary Elizabeth Holmes , on July 28. 1978
(Nome of Decedent) (Date of death)
who was late of 137 East Park Street. Carlisle. Cumberland
(Street and Number)
(Post Office)
(County)
Pennsylvania 17013
(State)
The secu.jties a.e .egistered as follows: Korinn Ilovfd Jlo>1moa and MIn:y ElfpN,th &1..... J~. Ton.
(Nome or names in which certificates ore registered)
~ ~""t"II1 n. HnlmAlII, 1~7 FAlII~ Parle S,.,.....~, Cm-HAle, Pa 1701~
EXECUTOR ~ (Nome) (Address)
NAME OF APPLICANT lm.T.T.lM F. MAImrw, P.C. At~
for Estate of Mary Elizabeth Hohpes
COUNTY FilE NUMBER '1-78-463 ADDRESS OF APPLICANT ,..., Roo.~ Rfg!> S"'-e. ('.....B.h. PA
170
BUREAU FILE NUMBER SIGNA TUR E OF APPLICANT k
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICA TlON, 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 9;#Ir. /~//frl
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Deceden t an d waive the fi r; n 9 of ace" ili cate ce" j fy i n 9 to the paymen I 0 f th e "an s fe. i nhe d tan ce tax to wh ich
the praperty of said Decedent is made subject pu..uant to the provisi ons of the Act of June 20, 1919, P.l. S21,
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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