HomeMy WebLinkAboutOC1971-0788 - ESTATE OF CARSONR C C-72 (6-67)
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
I
APPLICATION DATE Ju11 29.1971
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 Nation~6ti'~i8~~titftlCW&Wda~r~lln'outt;l,'..'....
(a).9906250 (b)1\aqQ 52 tfta$tJ V_sbington CO.,Colo,sdO(c)lo,alty iDtoJ'Qot;
(NOTE:'In describing securities enter in (a),ab Ole,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 ,and having a.TOTAL MARKET VALUE OF $- _
(Date)6 ..
as of the date of death of the'decedent,Am:elta LeubCG...OQ ,on >Octobor 21,19 6.
(Name of Decedent)(Date of death)
(Street and Number)'(Post Office),(County)(State)
(Name or names .in which certificates are regi~tered),801*14·01'Avoavo .~TOR~.J.hoo~~~~)caroo..···":DoI'o*,o,'G~~d~~~laU 15013
NA'ME OF APPLICANT ,.1.neston Co.:soa....'.....'801 ftilfan AVIA\UG
COUNTY FILE NUMBER 6:>~'71-'788..ADDRESS OF APPLICANT Doboto.POlmGy).v6ftla 1$033
BUREAU FILE NUMBER Same",SIGNATURE OF APPLICANT '---__---'---'--
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;
COMMONWEALTH OF ,PENNSYLVANIA -DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
DATEJu1y 30th.19'71
I hereby consent to the transfer of the above securities now registeredi~the name of the aforesaid
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,as 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.
SignedMe Secr:~of Revenue ..
By f;~/!?~
(Signature)
Register of Wills
(Title)(County)
Washington