HomeMy WebLinkAbout12-19-78 (2)
RCC-72 <9-68'
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT ~
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Associalion located in Pennsylvania:
r-:- ',-: :~~ Ct:." t c s b"...:. ~j - , "'....- .
(a) 12 ;:-:, ;:'''';:\ (b) ;1", t "",:r un':} ,J'US!; CO it..t:,' of/ (c)~'c'" or, :""OCi<;:
(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 dote of registered bonds.)
tasu~d ",of"l;,1" '7, l-:~}r '7 'or '0cY<' ~~b<:11~ns ~.'"f,.J '\.;(3rt~,"L'. ';' "Ji: LSS1JCC 1.,~;"~; i..J'l, 1":)
ISSUED ON Cert~ t. '2)1 / ,and having a TOTAL MARKET VAtUE OF $ 12()').:
DATE
'(':> ("I
t / e ]378
for two Ii1E
(Date)
as of the date of death of the decedent, :T t 10
. G 1 e 1 Pi t-~ (;
, on
~/(;-r-t. 27. :>'}7~J
(Name of Decedent)
(Date of death)
who was late of Ill;
~. SO:;
.'
. , . ,
eC'1ar.1.CS l)~}r, ~
~ \ ' "t"fl-:) f~ Y' 1 Ll1'C': \~
7:'i.." ;;11:".
(Street and Number)
(Post Office)
(County)
(State)
The securities are registered as follows:
19 S 11 ~ ~~ t~ 8 " --~ t}, 0
Cle18n~ ~Qr ? S~1~2S.
:avtd
",. .-' 1 ;.1'~, '
or
1'1('
..1.. ,_~ .
IJt;lc: '. Cli.;.l,Jl",\.:
:.01'
.
(Nome or names in which certificates are registered)
ADMINISTRA TOR)
EXECUTOR )
~..~ :"'l t 1 t: (; :1 r i ,
.i ,:) (~ <) r'; c; t .
. tt".
(Name)
NAME OF APPlICAN
COUNTY FILE NUMBER ;'1 _"7 -;~FADDRESS OF APPL
BUREAU FILE NUMBER SIGNATURE OF APPLICANT . c:c'.n~, tcs;;'~;r J :8 ::na.
NOTICE: IF YOU FAIL TO PROPERL Y FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
1(055
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES . ~
DATE...., 'L I C;
I hereby consent to the transfer of the above securities now registered in the name of the afores'aid
Iq?ry
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 Aptil 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 Secretory of Revenue
'"',
B~"'tt,\ f C~~~\.Q,~~ r_~~'~
, (Signature) . - ','Jif J' ,.y-,,\
1_3
:Title)
,:1'(
(County)
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,~' RCC4(2177) COMMONWEALTH OF PENNSYLVANIA
ill: NO. H 063706 DEPARTMENT OF REVENUE
,;i OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
ilt
~
:=! RECEIVED
,i
i=i
'1
!~ From:.-.CMyrt1e Itohr)
~
H Address Market Square Bldg.,
i
II
~"
POUR THOUSAND DOLLARS
collars
representing Pennsylvonio Inheritance or
Estate Tax due from the following estate:
2 o/~ Tax on
$
$
6% Tax on
$
$
Mech&n1caburg,Pa.
No.
21-78-572
Date of Death
17055
9-27-19'78
15 % Tax on
$
$
County
Cumberland
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_ % from
to
$
4,210.53
~
,U
~'
~
e of Payment
December 19,1978
% Tax on $
Estate Tax, Act of
Moy 7, 1927
$
$
Name of Decedent
MYRTLE E. CLBLABD
! Remarks:
$
210.53
PAID OR ACCOUN'l'.
uOO~[P~~@illu~
SEA L
OTE: This Triplicate Receipt to be retained for audit purposes.
Received by
NOTE, In accepting the transfer inheritance tax an future estates. prior to the death of the life
tenant or tenant far years, as evidenced by this receipt, it is understood that the Commonwealth shali
not be precluded or prevented from hereafter assessing additional Inheritance tax at the deoth of the
life tenant or tenant for years whenever It appears that such additional tax may be legally due and
collectible far any reason whatsoever.