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RCC-89
COMMONWEALTH OF PENNSYLVANIA
Department of Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
September 29, 1978
(Date of Entry)
1. Name of decedent:
Mary E. Stansfield
2. Address of decedent:
15 E. Main Street, Shiremanstown, Pa. 17011
3. Date of death:
September 29, 1978
4.
Name and address of person who requested the opening of the box:
Vera L. Whisler
13 E. Main St., Shiremanstown, Pa.
5. Name and address of the financial institution where the safe deposit box is
located:
Commonwealth National Bank, 2 W. Main St., Shiremanstown, Pa. 17011
6. Number of box:
123
7. Title under which box is registered: Mary E. Stansfield or C. Herman Stansfield
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: 4/28/7' Charles E. &
C. Herman Stansfield Co-Executives - Harold E. Sheely Attorney
September 78
And now this 29th day of , 1~ , I hereby
certify under penalty of perjury that the above record is correct and complete
to the best of my knowledge and belief.
f3fcu ~ >~ >'3?;~~
Signa turer
Charles R. Bishop, Assistant Manager
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