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id'PLlCA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
tei
;,
AEfJ;:..i~:ATI''}tl (j.,iU T BE FILED IN TRIPLICATE)
TO THE PEt-Jrv'r_vANIA DEPARTMENT OF REVENUE:
till" corior' is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporar:c;.n ,,: Cl Na~")nal Banking Association located in Pennsylvania:
DATEMareh 23, 1979
(af .--1.0--..-- (b) Cumber land- Valley Cooperative AS80C. (c) Preferred
(NOTE: in de:)cribing securities enter in (a), ab (Ne, either the number of shares of stock or the face amount of
registered bones, iI', (b), :\te <',Clme of the issuing company and in (c) the class of stock or the stated interest rate
and motJriit Gote "eqi~,tered bonds.)
ISSUED ON_~!l~.__2~, 1965____; \md having 0 TOTAL MARKET VAilUE OF $100.00
i I')otp}
as of rnc dote of r!'::clh of the decedent,
Ch.rles PO. Brown
(Name of Decedent)
,on September 2, 1978
(Date of death)
who ,/os I(]tc oS.oS_S.ouj:h. York St. ,____ Mechanicsburg. Cumberland
'S'reet and Number) (Post Office) (County)
Pa.
(State)
Th,~ securife~ 'Ct': re9istered os follows: Char1e&--F-. Br~ or Dora E. Brown
(Name or names in which certificates are registered)
Clifford R. Brown 302 East Harble St.,Hech&Ilicsburg,Pa. 17055
~ leab.ll@ ~OWDLFor8h.y 401 NOTt~ ~9rk~t ~t. .Martin.burg.~a. ]6662
EXt.CUTORS (Name) (Address)
NAME OF APPLICANT
Clifford R. Brown
302 East Marble St~
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES Sf
---- DATE 'L I J.. (~1l1
! herebl consent to the transfer of the above securities now registered in the name of the af esaid
Deced:O:l11 and "'oi,e tf" filing of 0 certificate certifying to the payment of the transfer inheritance tax to which
,he property of soiJ Dccdent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as amended y,d the Act '1 June 15, 1961, P.l. 373, as amended. This is also in accordance with the provisions
of the Act of April 91 1929, P.l. 343.
Thi." Consent to Transfer the herein described property operates only in reference to the estate of the
abo'ie-named !),;cede'1t.
Sig~~~ the Secretary of Revenue
By '\ '1y. d'1O.J L ~~VL (1'-~.
(Signature)
(Title)
(County)
<".
',:.
APPt leA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
t..L.
At'f.kICAI~ tiU BE FILED IN TRIPLICATE)
TO THE PENf':')YL VANI A DEPARTMENT OF REVENUE:
A:"llcati')'l .:; hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporatio!' Gi C IJat,;:.nc: Banking Association located in Pennsylvania:
DATE March 23, 1979
(aL__n._a~__ .'_ __jb1nn_Commonwealth National Bank (c) Capital Stock
(NOTE: h ribing s curities enter in (0), ab Ole, either the number of shares of stock or the face amount of
reglslcld,~ ,io1 (b), .:,'~ nome of the is!>Jing company and in (c) the class of stock or the stated interest rate
and maturiry ink of relli' tPred bonds,)
I)SL'ED O~L ~lIn.ar-l975---- i and having a TOTAL MARK ET V AtUE OF $3010.00
~Oate '.
os of thl' dott ,;.' di"ath ot the decedent, _j:~ar!~s F. Brown _, on September 2. 1978
(Name of Decedent) (Date of death)
whc \lias lor€' oLlO3- South York St.
'S"ef" and Number)
Mechanicaburg, Cumberland
(Post Office) (County)
Ps..
(State)
The securitirl';;;;:; reg,';i{"ed os toHows: Charles F. Bro1t1lL.
(Nome or names in which certificates are registered)
~ - ) Clifford R. Brown 302 East Marble St., Mechanicsburg, Pa.1705.
+~~,~) ..Isabe11aBrown Forahey 401 North Market ~t. ,Martinsburg, Fa. 16662
~~........~ (Name) (A dress)
NAME OF APPLICANT C1!52ord R BJ."own
. Elit )ifarble St.
COuNTY FiL.F j~Ut,'.S'~FL---2--l-78-485'- ADDRESS OF APPLICANT Mec. i Pa.
c:.. ...'~ ~/ -;/4,
BUREAU FiU? NUMBER_n___________SIGNA TURE OF APPLICANT ,---'Uc., ~L?G-'
NOTICE: IF YOU FtdLTO f>ROPERL Y FILL IN ANY PORTION OF THIS APPLlC I 1'1, IT WI L HOT BE
CONSIDERED COMPlEH: AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMm~WEAL TH OF PENNSYL V AI~IA - DEP ARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES G? t q
-----. DATE ~'- I ~ ,"1
CDi.sent to the transfer of the above securities now registered in the name of the afo said
, hereL;'l'
Derede.i\ :.mclil(1i"'f: lhe fil!'1g of a certificate certifying to the payment of the transfer inheritance tax to which
the pro[:2rtv ," "e'! Dn:cu~r,t is mode subject pursuant to the provisions of the Act of June 20,1919, P.L. 521,
as amenued unci ,he Act of Jl:i1", 15, 1961, P.L. 373, as amended, This is also in accordance with the provisions
of the /lct)f t; Ii 9, 19.29, P,L. 343.
TL. s Cansent to Transfer the herein described property operates only in reference to the estate of the
c~ove.namE'd Decedent.
Signe~f.07the Secretary of Revenue
By {. fri',. { 'Ii. ,J. t aYlIJ, 1.01;'1., :f' ~
. l (Signature).
(Title)
(County)
(( ,
,t>
,>PPUCA TION FOR AND CONSENT
TO TRANSFER SECUR!TIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
bl
Lle.E:.=..J!"'~TE}l:J ~'W,YT B~: F!LED ilN TRIPLICATE)
TO THE PErl"JSv tV jI,NIA DEPARTMENT OF REVENUE:
,ii,') :1'>.::1<:(1 is hereby mode for consent to the transfer of the following securities of a Pennsylvania
Corpor:.>'ion or ;; t,h, (Ji1ni Banking Association located in Pennsylvania:
DATE Mar~~'3 J979
.
(a)__}g3?.~~.3.tD;._JInite~Llncome Fund (c)
(NOTE, in (ksc(ibing s0c~lities E~nte, in (0), ab Ole, either the number of shores of stock or the face amount of
leQi.,t"'r,<:' r..,~;s. ib, the :,Cl'~e p:r :hc 'ssuing company and in (c) the class of stock or the stated interest rate
and mC'unty UCTe ,~;t ;egi~tered ber.ds.)
ISSUED ON _Y~rious. ~~tas ,!]nd having 0 TOTAL MARKET V AILUE OF $ 10,472.99
\ r~,(,t,~~)
as d Iht; dJ'(\~ (\i,;0'1 of the decedent, ,Gha-rles F. Brown
(Name of Decedent)
, on
Se~tember 2, 1978
Date of death)
whr. '10S :otc~,t3Oa-South~-oU--St..,.---Mechanicsburg,
\5',ee' and Numbel'} (Post Office)
Cumberland
(County)
Pa.
(State)
T~e securitif's t re r"g;<:terf'd as follow:::. Charles F _ Brown And Dora E Rrown
(Nome or names in wh i ch certifi cates are registered)
~
EXr::r' IT""'"
,._,~ l) ,Jr', S
Clifford R. Brown 302 East Marble St.,Mechanicsburg,Pa.17055
--laabelle..Brown Forshey. 401 North Market St. ,Martinsburg .Pa.
(Nome) (Address) 16662
t~AME OF APPLICANT Clifford R. Brown
302 East Marble St.
comny i' L~: N~)MBER -tl--18-4&5---.- ADDRESS OF APPLICANT
BUREAU FIL}5 ~WMBER____..__.____SIGNATURE OF APPLICANT
NOTICE: ,7 yOU FAil TO PROPERLY FILL IN ANY PORTION OF THIS APPLlCA I N, IT WILL." NOT BE
CONSIDE~ED COMPLETE: AND WiLL BE RETURNED TO YOU FOR COMPLETION.
COUADNWEALTH OF PENNSYLVANiA - DEPARTMENT OF REVENUE
fONSENT TO TRANSFER SECURITIES DATE C-i , ?
r.c"St~nt '0 the transfer or the above securities now registered in the name of the afotid
I t1 'Jf
I' ere
DeceJ,,'r;i QI'O wa;"".: f Lng of a c:ertificate certifying to the payment of the transfer inheritance tax to which
ti'~ property -:1; $0 i D!'.:cedent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as arn"nueLl mid tht: !,c".fLoc 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Ac! 01 April 17, lQ;':9; P.L. 343.
T:'lj ConsePT to Transfer the herein described property operates only in reference to the estate of the
rr~:Y,<,e-nar.lE'd Decedent.
Signed for the Secretary of Revenue
,/-) . A D I
By(/ >f p lljJ."" f. ~<l hav"l. ~'3\. ~{>-
(Signature)
(Title)
(County)