HomeMy WebLinkAbout04-19-79
COMMONWrAl.l1t 01 I'rNN~Y I VANIA
DEPA,nMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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APPLlCA TION f' 1I~ AND CONSENT
TO TRANSFE I~ SECURITIES
REGISTERED IN THE NAME
OF A RESIDE!~T DECEDENT
A!q~~.
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APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for coosent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Associalion located in Pennsylvania:
DATE
4/18/79
(a) ~ 000 sh~(b)_-SWl & Sp1ash----HM~ Club---Ine.' (c) ~n
(NO ~: In escribing securities enter in (a), a Ole, ei'ther the number of shares of stock or t e ace 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
7 22 78
(Date)
as of the date of death of the decedent,
, and having a TOTAL MARKET V A<LUE OF $
5,000.00
on
Lester Go Bixltlr ,----Jr-.------ ,
(Name of Deceaelft)
ll~-.
(Date of death)
who was I ate of 50Z] Wood box I.ane
(Street and Number)
Mechanicsburg
(Post Office)
Cwaberlaud
(County)
PeRPI.
(State)
The securities are registered as follows:
-Lester .-G..-.Bixl..,----jJ!-..----.---
(Name or nomes in which certificates are registered)
1510 Cedar Cliff Drive
.CUlp m},~5S~enna. 17011
NAME OF APPLICANT Suellyp Bixler and Commonwealth National
Bank
COUNTY FILE NUMBER 21-78-668 ADDRESS OF APPLICANT see above
eNB,..., Ilx: ~lL........... ~ Trust Office
BUREAU FILE NUMBER_~__SIGNATURE 0.- APt-'L1LAN I~.v,j~ ~~J\..J
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLICATION, IT~ILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
. DA TE ~rt!h.:{3 Lq7r
I hereby consent to the transfer of the above securities now registered in the name of th~
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, os amended. This is also in accordance with the provisions
of the Act of April 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.
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Signed for the Secretary of Revenue
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