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COMMONWEALTH OF PENNSYLVANIA
Department of'Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
September 21. 1978
(Date of Entry)
1. Name of decedent:
JOHN C. DIRST
2. Address of decedent: 3424 Bedford Drive, Camp Hill, Pa. 17011
3. Date of death:
September 16, 1978
4. Name and address of person who requested the opening of the box: John L. Dirst
7309 Dickenson street, Springfield, Virginia 22150
5. Name and address of the financial institution where the safe deposit box is
located: Dauphin Deposit Bank & Trust Co.
3045 Market Street. Camp Hill.
1116
Fa. 17611
6. Number of box:
7. Title under which box is registered: Dirst, John C.
8. Was there a will in the box? (Yes or No) yes
~. If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of attorney, if any: John L. Dirst
June 22. 1976
7309 .pt-.e)'~M>l11.:$t. Springfield Virginia 22150
MYers. MYers, Flowers & Johnson
And now this 21 day of September , 19 78 ,I hereby
certify under penalty of perjury that the above record is correct and complete
to the best of my knowledge and belief.
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Signature
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