HomeMy WebLinkAbout12-27-78
RCC-72 19-88)
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYL VANIA DEPARTMENT OF REVENUE:
Application is hereby made for coosent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
Industrial Valley Bank & Trust Company
(a) $550.00 (b) Bank Subordinated Debenture (c) ] 2/1/RO - 6\1;
(NOTE: In describing securities enter in (a), ab Ole, either the number of shares of stock or the face amount 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.)
APPLlCA TlON FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME i
OF A RESIDENT DECEDENT J
-~~~--~._~-~---- ~~~---
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
Dec. 27, 1978
ISSUED ON December 1, 197,~nd having a TOTAL MARKET VA>lUE OF $----550-.00
(Date)
as of the date of death of the decedent,
JOHN C. nInST
, on
September 16, 1978
(Nome of Decedent)
(Date of death)
who was late of
,474 'Rp-n~nrn nri'tT€,
(Street and Number)
camp HiJl
(Post Office)
Cumberland
(County)
Pennsyl'Tania
(State)
The securities are registered as follows:
J. C. DIRST
(Name or names in which certificates are registered)
~k~T@BQ
EXECUTOR )
JOHN L. DIRST 7309 Dickenson St.,_ Springfield, Va.
(Name) (Address) 22150
NAME OF APPLICANT __ MYERS, MYERS, FLONER & JOHNSON
COUNTY FILE NUMBER 21-7R-~31 ADDRESS OF APPLICANT P.O.~I.~:{~e.d;~.' Pa.
BUREAU FILE NUMBER SIGNATURE OF APPLICANT { , (,
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APfQ..1C . ~N,'J:!ri ''If<<)1'-TJre.'~
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION. 'J:
17043
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ~'l' I'> 1 r
DATE ~-
I hereby consent to the transfer of the above securities now registered in the name of th aforesaid
Decedent and waive the filing 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 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.
s~. oed 0; the Sec..'o<y of Rev","e
~~~ E'- CY'r?h~~_
(Signature)
Rrr:F~:\:l,!1 jl,n~1rry.'~,'J~
FEG'j':nER OF W!U3
--(Titl-;) L,.\;,~;c:Ar.n \AJ1te'ounty) -
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