HomeMy WebLinkAbout04-06-79 (2)
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APPLlCA TION FOR AND CONSENT
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE TO TRANSFER SECURITIES
BUREAU OF COUNTY COLLECTIONS JI REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
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APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPART~ENT OF REVENUE:
Application is hereby made for crosent to the transfer of the following securities of a Pennsylvania
Corporation or a National Bonking Association located in Pennsylvania:
DATE
.:J~Ll~;Y___ _1-1979
(a) 112 ( b) -1Jni td _'l,?j.~lll!JlJnica.ti~..Inc.-._ __. .__ ..._.._ __ _ ( c) ____5e>n!loE:.______
(NOTE: In describing securities enter in (0), ab Oie, either the number of shores of stock or the face amount of
registered bonds, in (b), the name of the issuing company and in (c) the closs of stock or the stated interest rote
and maturity date of registered bonds.)
ISSUED ON May 29, 1973
, and having 0 TOTAL MARKET VAtUE OF $_______21_~.4__~OO_________.._
(Dutej
as of the dote of death of the decedent,
(Name of Decedent)
on October 1, 1978
__n_____ , __________
(Date of death)
Eva M. ~ans
who was late of
Star Route #2
.___._._~~p~sE~._.
(Post Office)
Ctmber1and________.R.~~vania
(Street and Number)
(County)
(State)
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The securities ore registered as follows: ____ Eva ~~_~~______
(Name or names in which certificates are registered)
Jacob o. r-t'Curdy and Richard M:.'Curdy
R.~.#3,(~) 221 ---p:- o. BOX 17,-St-:-Tn~tld~~'-I72-S2---------
Shippensburg, PaNAME OF APPLICANT .1<=lCOO-O-aOO.--Ri.GhaFG-McCurdy
COUNTY FILE NUMBER 21-78-586 ADDRESS OF APPLICANT _R-.!B~jJ:3/~221.___P.Q~_I30UL__
Ship~Sburg,~. _ St. Thomas, Pa.17252
BUREAU FILE NUMBER SIGNATURE OF APPLlCANT,~~~~...1/~fB!i ---
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTIOl'4 OF THIS AP'trCAff6N~"lhILL Noi~
CONSIDERED COMPLETE AND WILL BE RETURl'4ED TO YOU FOR COMPLETION.
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EXECUTORS }
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~
----.----------- ---.-..----- DATE -b--19..7:(
I hereby consent tv the transfer of the above securities now registered in the nome of the 0 res'aid
Decedent and waive the filing 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 and the Act of June, 15, 1961, P.L. 373, os 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
B~A ~ L~'1Jo.u
~\~i;o'lIre) \J ,~y\
Ilm\~!) l!. ANorn~""
RfGiSTER OF WILLS
:Titbt1.ifJ6HlUlNO COUi'tll (County)