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APPLICATION FOR CHARITABLE EXEMPTION
FROM PENNSYLVANIA TRANSFER INHERITANCE TAX
(Act of May 28, 1956, P.L. 1757, and Act of June 15, 1961,
P.L. 373, as amended)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
SUREAU OF COUNTY COLLECTIONS
Application is hereby filed for the approval
of an exemption from Pennsylvonia Transfer
Inheritance Tax on the transfer of the property
described below:
1. Bureau File #
21...78...324
June 12, 1978
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2. Date of Death
3. Da te of Approva I
4. Name of Decedent Carrie May Anderman
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 166.00
(Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value of
the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift
or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases
enter such fractional or percentag.e amount above).
6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless
such material has been previously filed.
WILL QS:
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, ~xplain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME The Salvation Army
AD~ESS 1122 Green St.reet Harrisburg" ppnnflylv~:ni~ 17101
G' See listing on reverse side for additional charitable organizations covered.
8. I certify that the informatio~d. herein is, to the best of my knOWledge. and belief, true and correct.
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Signature 'of Applicant Rober't.vJ1. O'Hara .
Address of Applicant 130 Hummel Avenue, Lemoyne" Pennsylvania 17043
Official Title Executor
Date Sp.ptember
1978
This form must be completed in triplicate and all three copies delivered to the Register of Wills for the County in which the decedent
resided, or in which letters were issued for a non.resident decedent's estate. If the decedent was a non.resident of Pennsylvania and
letters were not issued by a Pennsylvania Register of Wills, deliver all three copies to the Directar, Bureau of County Collections,
Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Pa.
Do not write below this line. For Official Use Only
APPROVED: For the Secretary of Revenue REFERRED to Bureau Headquarters
Approved 0
For Secretary of Revenue
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~t..d,lAt t: ,'vYlC 'l,Otr;...
(Signature of Register of Wills)-,
Denied* 0
(Initials of Register of Wills)
(Authorized Signature)
(county)(~.. i
)(;''v
(Date of Approval)
(r~ !(.r2L
(County)
(Title)
(Date of Referral)
(Date of Action)
* See reverse side for reasons
MUST BE FILED IN TRIPLICATE
This section will be compl eted by Bureau Headquarters only when the application for exemption has been denied.
Date:
The application for exemption contained on the face of this form has been denied because
Note: Any party in interest, including the Commonwealth, aggrieved by this action may within sixty (60) days after
the date of this notice exercise their rights of Protest, Notice, or Appeal in accordance with the provisions of applicable
Pennsylvania Inheritance and Estate Tax Acts.
Item Fourth of Will:
Cerebral Palsy Center
15 South 80th Street
Camp Hill. PA 17011
Bequest
$ 1. 000. 00
Item Fifth of Will:
Citizens Fire Company
W. Herman Avenue..
Lemoyne. PA 17043
Bequest
500.00
Item Fifteenth of Will:
ChUrchville Cemetery Association
(Oberlin} Cemetery
51 South Harrisburg Street
Oberlin. Dauphin.County
Pennsylvania. 17113
Bequest
1. 000. 00
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