HomeMy WebLinkAbout10-19-78
R C (>72 19-68)
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT ~_____
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUf'-EAU OF COUNTY COLl.ECTIONS
APPLlCA liON (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYL VANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Associal ion located in Pennsylvania:
10 lfj-78
(0)-5.8.. ShaT~C; (b)--Cnmmnm./,(.\;:;]t; ~.T;!'t'i oaaL Tlank___ (c) ComrnonStock .__________
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of s\'ock or the face amount of
registered bonds, in (b), the name of the issuing company and ir, (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON Various f'ate~
(Date)
as of the date of death of the decedent,
{and having 0 TOTA~_ .'i\ARKET V",' UE OF $_-1!lS2..QO
Harry P. .R~ber~_"_H_'_'_'___' 0I'1_^Ugl!S_t.....6J,.c)78
(Name of Decedeo" (Dote of death)
who was late of-ZillL Walnut BottQJLJ!.oad ______ CJlrli$_bL._______Cum.b,y.lmd_.____._FMruiylvania
(Street and Number) (Po'; Offi ce) (County) (State)
The securities are registered as follows:
Harry F. Ruh~rt .__._________.______
(Name or names in >,hich certificates or" registered)
~~iMi~ The Ccrn::nonwealth National Bank, 1 ~1;,lD~Y...~:r_S_L..uCarlisle, Pn.. 17013
EXECUTOR) (Name) (Address)
NAME OF APPLICANT Tnp. ('rnmnnnwp.1I11'h _.NationAl R:mlc
.
COUNTY FILE NUMBER 2l-78-A33 ADDRESS OF APPLICANT 1 fI,'''/~:~j
BUREAU FILE NUMBER SIGNA TURE OF APPLICANT I~../' :?~.:...
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT B
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
13
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~ j 19 Ie?
DATE ('~ ~ I~Y
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 provisiol)s
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.
S;;gfO; Z~~e'o'y ~qm"""
B"/ -L' '_, C~G\~I > ~
(Signah),~,eJ)::" M;DEf1StJ/I ' "'"
;W? OF WiltS '
_____u_. _' _ _~~~!i[l ~QlJ~.rt __ ~ ~_n n__
(T; tie) (County)
il,j (l t1lo I'X":"l~C!;" / J\ +:'1in;,:l,,;'~'
h" 1 '" L, ..."" " J.'., >.il.L,.
shown on the h d
pa1jment, within th,~
Penns~lvaDia lnheriu:
transfer of the securi'j,
to transfer is granted.
~t ~state as transf8r~9
,,] 118rshlJ guarantee thr.
,)iTL:db~1 law, of a.1l!]
v wh:rh m~ll ctuP. on Jl3
..... .... ~v._. A. ......:J
hereon hu: W;11Ch a,..01i811'
Data \o\<-t;.~B~