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RCC.3 (4-73)
APPLICATION FOR CHARITABLE EXEMPTION
FROM PENNSYLVANIA TRANSFER INHERITANCE TAX
(Act of May 28, 1956, P.L. 1757, and Act of June 1S, 1961,
P.L..J73, as amended)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
Application is hereby filed lor the "approval
of an exemption from PennsylvaniC! Transfer
Inheritance Tax on the transfer of the property
described below:
1. Bureau File #
,..:u- 7Y- Iftj-
"
April 5, 19'1R
S cAO?7'. fC,'ll"
2, Date 01 Death
3. Date 01 Approval
4. Name of Decedent Maxine V. [rape
1
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $
(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 e~tablished by appraisal by the Commonweal_th, except in those cases where the amount of the gift
or bequest represents a stated fractional ar percentage portion of the entire estate or the entire residue. In those cases
enter such fractional or percentage amount above).
6. Check the manner in which the transfer was eHected. and submit.a copy of the document authorizi.ng the transfer, unless
such material has been previously liled".
WILL~;
DEED 0;
. TRUST INDENTURE 0;
SURVIVMSHIP 0;
OTHER 0;
(II ather, explain)
7. Correct Business Nome and Address of Charitable Organization receiving property:
NAME
John M. Eakin. Trustee, See Attached Will
ADDRESS Market Square Building, Mechanicsburg, PA
D See listing on reverse side for additional charitable organizations covered.
8. I certify that th.einformation contained herein' to the best of my knowledge and belief, true and correct.
\ ~
170')')
Signature 01 Applicant
Address 01 Applicant
Ollicial TitleTrustee under Will
()f lVf;:nri np.
Krape
V . IDate
,
September 8, 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 Director, Bureau of County Collections,
Penna. Department of Revenue, 26 s. 4th Street, Harrisburg, Po.
Do not write below this line. Far Ollicial Use Only
APPROVED: Far the Secretary 01 Revenue REFERRED to Bureau Headquarters
Approved 0
For Secretary of Revenue
~~[ D~Jv~~
(Signature 01 Register 01 Will
RI~~,~~~-)~~~~
(c}l3f.W)~ii ciiU:~:1
Denied* 0
(Initials 01 Register 01 Wills)
(Authorized Signature)
(County)
(Title)
(Date 01 Approval)
(Date 01 Referral)
(Date 01 Action)
* See reverse s ide for reasons
MUST BE FILED IN TRIPLICATE
.
This section will be campi 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.