HomeMy WebLinkAbout09-09-81 (3)
APPLICATION TO
TRANSFER SECURITIES
FILE NUMBER:
COUNTY 21-78-680
REV-517 EX+ (2-80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
REVENUE
NOTE: THIS APPLICATION MUST BE FILED IN TRIPLICATE WITH THE REGISTER OF WILLS FOR THE
COUNTY IN WHICH THE DECEDENT RESIDED AT THE TIME OF DEATH.
Name of Decedent:
Clara I. Way
November 25, 1980
110 Dauphin Street
DATE
9 ,ih;/
I
6/
,
Date of Death:
Address of
Decedent:
Eno1a, Penna.
(CITY, BOROUGH) (STATE)
(COUNTY)
DESCRIPTION OF SECURITI ES:
1. Stocks a.
345
(NUMBER OF SHARES)
b.
CODIIlon
(CLASS OF STOCK)
c.
CCNB Corporation
(NAME OF ISSUING COMPANY)
(Replacement Certificate)
d. June 3, 1981
(DATE OF ISSUANCE)
e.
$ 3.450.00
(DATE OF DEATH
TOTAL MARKET VALUE)
2. Bonds a.
b.
(FACE AMOUNT) (INTEREST RATE)
c.
(MATURITY DATE)
n. e.
(NAME OF ISSUING COMPANY) (DATE OF ISSUANCE)
f.
(DATE OF DEATH
TOTAL MARKET VALUE)
The securities are registered as follows: John M. Eakin. Executor of the Estate of Clara I. Way
(NAME OR NAMES IN WHICH CERTIFICATES ARE REGISTERED)
Name of Applicant:
Address of
Applicant:
John M. Eakin
Market Square Building
Mechanicsbur~. Pa. (Cumberland)
(C!TV. BOROUGH) (STATE) (COUNTY)
CONSENT TO TRANSFER SECURITIES
I hereby consent to the transfer of the above securities and waive the filing of a certificate certifying to the
payment of the transfer I nheritance Tax.
~ 9', /q't;
(DATE)
'---