HomeMy WebLinkAbout10-03-78
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v1 )/ COMMONWEALTH OF PENNSYLVANIA
c: / Department of Revenue
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ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
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(Date of Entry)
1. Name of decedent:
fJf:rT't 1. p E. :;'. e J [mJ
2. Address of decedent:
fiI. GimDson st.
M8C~9ni~sbvr~1 ~? l?OS~
3. Date of death:
Sentemher ?7, 1?78
4. Name and address of person who requested the opening of the box:
~1rT'tJe ~. l{o};r - ljne:; S{>c-nd st., Uj_e;ns::,iY>(~, "Dn. } '70':;/1
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5. Name and address of the financial institution where the safe deposit box is
located:
mlr- -') "Fli~ ,~t B9.~ l,;rqn'J m-yll 1~ i~ S orrrI!2.n~r of 11e (~:t~'Jln.2- '0 ?~~~'l) r=, ~A.
6. Number of box:
1 (~: )']
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7.
Title under which box is registered: 1\"yrt1 e E. (;1 ~~10rid m'(~ lff.:/,Y"t;lP8.
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B. Was there a will in the box? (Yes or No) Yes
9. 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: Al'3. J?, lorn::.
Ni;/r-f:;l e VOhT', 'jyp:.::utrix, hOc) F:.econ:'1 ~t;., EiSh::'2Jire, T\3.
:J. P02C,"-f:; ~t-'911ff'P:r', fi!3"kc+; O,-:1JJ1T'C: ~ld3., !Vf:;--;!1cm;C sb1Jrc, DC. 170~5
And now this :';:":'0 day of Oc+obpr
certify under penalty of perjury that the above
to the best of my knowledge and belief.
, 19 '78 , I hereby
record.l A correc. t and complete
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Signature
?J\.IR-ILIA L't:.\~
Print Name and Title
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