HomeMy WebLinkAboutOC1971-0506 - ESTATE OF YORTYRCC·72 (9·68)
COMMONWEALTH 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 Na_tional Banking __ t:\ A __ ssociaJlon loc~d in ~Dj»'llt(9i~: ;_ . . I'IMT NA'l'IONN.t BANK & 'Tkw, ·.r ·~'· ... (a~03 shates (b) WA$HING'l'ON,. fA•· (c) c.~Qlf ST.QQ:K
(NOTE: In describing ·securities ente'r ih (a), ab a~e, either the number o.f shares of stock.or the face amount of
registere.d bonds, in.(b)/the name of the i~s:uing_' compa~y ~nd in (c) the clas·s ·of stock 6r 'the stated interest rate
and maturity dot~ af registered bonds.} ' ' . . . . . .>
J
· ,. · · ·· .· ·.' · · · ~· .:· ·' . .-· . · . :· ~ i;dr/:.
ISSUED ON Dec.· 3, 1968 : . :·and haying .a TOTAL MARKET VA1LUE OF $1....,·2-+-''"--'",J:L-:' ~,..,.0_,-~_0-,-·0_-____ _
. . . ' cp'at_~)> : ;..:: . <: ?:.:'. ' ; ... ":_ ... y; It . ' ·, ,· j, < '·~ }t-~:~it~ 25, 1971
as of the date'cifCI~ath cibhedece~ent,·, ~ery .~ .. ,. .. P' .· .'!fl.· , -, .. ,·-:,-,, ,;' oMk· ·' ' -~--. "" .. :· '-:
' .,·-"' . . ; ,1 : . i ' ' . ' . \ ' . ' : ' . • ~1-1 { • 1 . '
' ; , ·; •. ; , (~_ame o,q>ecedent) ,, · r,. \ -~ ~#~ ·. 'i,(Date of death)··
' . ·~ • I . >" ~ • ' ~ .. f ~; • 'j ' -, ~' ' ;• ·~ ;·\ ~~, ' <~-~ \'
who was late of. . .. .. ' Ft'~c'leri.ckt:o'Wn;· Pennsylvan.ta (Was~gton county)
· {Street q~d N~m'b~·~) ': ; ' , . ,' (P,ost Office) (County)t', :; '·' (State)
I ., . ~·
The securities a;e registered' as foUci~s: '!!!aq, ~ ~ony ;mel-HUgh Yo,ttyr.,f':ft, •;-'llt911to
' ·: ' ''. ', ·' '• (Nam'e or name-~ in which certificates are re~istered)•
15333
BUREAU FILE NUMBER same SIGNATURE o'F APPLICANT.,:!::·V"':._···---'..:¥¥~~,--:.,.~~t::::t----
NOTICE: IF YOU FAIL:.TO,~RQP.ERLY.FILL IN ANY"PORTION OF TH'I'S APPUCATION, 'I WICt,;i
CONSIDE~·~D:'~OMPL,ETE AND,_ WILL .. BE RETURN·ED TO YOU-FOR COMP{E.TI N.' . '
COMMO~W.E,ALTH OF PENNSYLVANIA..,. DEPARTMENT OFR.EVgN_UE
· · ·· ·. · CONSENT TO rTRANSFER SECURITIES' · · ·· -.. : , . " . .. . · · . ,.' ' ' · -· · ·· · · · . .· .: DATE May 18 19 71 •.
__ , I hereby cons·~n,t to ~heAransfer of the cibo,ve secu~Hi.es now -r~gistered i~ th~~-~_anl~ ~f, th~ a.foresaid -· _/ (' .' ;: : ->-. •·. 1 ,_ : • : .• \ ' •' :: •. : l. ' ' • •' ~ \ ·.· \-' • ' : :. ; . .:.'. ;: • '
Decedent and waive the filing of a 'cEirtific'at'eic;:ertifying to the payment o_f ~h·e trqnsfer .inh~ritance tax to which
. . . . ,.~ ' ' t ~ 'i .. • .. .. . • t ·:
the property of said Decede,nt is made' subject pursuant to the pr~vi-~ion~ of the A~t of June 20, 1919, P.L. 521,
' 1'• 1'
as amended and the Act of Jun~ 15·, 1961, P.L. 373,·,as a_~end~d •. This is also in accordance wiith the provisions
·of the Act of April 9, 1929, fl-·~· _343. ,
'l '•J
This Consent to Transfe~ the herein .d_escdbe·d prop~rty operates only in-reference to the estate of the
above-named Decedent.
l .
\ \ \,
(Signature)
Russell:. Marino Washington
(Title):
_;,.
:·''t' ,_._
(County)