Form Rev-1381 Ex - Stocks/bonds Inventory

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REV-1381 EX (6-98)
TO BE USED IN CONJUNCTION WITH REV-485
START
STOCKS/BONDS
ESTATE OF
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
FILE NUMBER
DEPARTMENT OF REVENUE
DEPT 280601
SOCIAL SECURITY NUMBER
HARRISBURG, PA 17128-0601
NO. SHARES/
STOCKS/BONDS
CLASS/SERIES
COMPANY NAME
CERTIFICATE/ BOND NUMBER
DATE OF ISSUE
DENOMINATION
REGISTERED IN NAME(S) OF
MM/DD/YYYY
PRINT FORM
Reset Entire Form
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