HomeMy WebLinkAbout09-10-79
REV-517 (8-78}
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
APPLlCA TlON FOR AND CONSENTJ
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPLlCA nON (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 Association located in Pennsylvania:
o A TE--5eptMber 10, 1979
(a) 12 (b) arntown Bank (c)_CtPltel Stock __
(NOTE: In describing securities enter in (a), ab CNe, 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.)
ISSUED ON 8/1/62, 1/6/66, 1/1~~~~ having a TOTAL MARKET V A'lUE OF $ 1,224.00
(Date)
as of the date of death of the decedent, G. RaYIQ1d Foael8Oft9llf" ___, on Nov..r 23. 1978
(Name of Decedent) (Date of death)
who was late of
(Street and Number)
104 EMt Burd St....t, ShIDOenabura.
CuMberland
Pttnns.,lvan la
(Post Office)
(County)
(Stai~e)
The securities are registered as follows: G.~ fogeleonger or ar_ F. AtlllOn_____
(Name or names in which certificates are registered)
G. Leonard fogelaonger
G,... F. AU'Rn 66 E_t King St., Sh'~g. PA 17257
(Name) (Address)
NAME OF APPLICANT Grace F. AU leon
104 E_t aurd Sf....t
ADDRESS OF APPLICANT Sh'DPtMburg, PA 17257_
/ . --- --
BUREAU FILE NUMBER SIGNATURE OF APPLICANT ,>,,'z-/ ;::-(!t? ~' <-d (~;:':-t<';f-+~_ '
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
ADMINISTRA TOR)
EXECUTOR )
COUNTY FILE NUMBER 21-78-657
COMMONWEAL TH OF PENNSYLYANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES t1)"..~....
DATE:~PC1",._16...19t;f
I hereby consent to the transfer of the above securities now registered in the name of the atores(Jid (
------------~------~._-~-~_.~-
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.IL. 521,
of the Act of April 9, 1929, P.L. 343.
as amended and the Act of June 15, 1961, P.L. 373, as amended. This is o/so in accordance with the provisions
above-named Decedent.
This Consent to Transfer the herein described property operates only in reference to the estate of the
s~~ned I , the Se~'e~'y of Revenue
By_' i.' _~ ~C ~y~~~_
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'. Title)+\"', (County)
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