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RCC- 3 (1-69)
APPLlCA TION 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
BUREAU OF COUNTY COLLECTIONS
Application is hereby filed for the approval
of an exemption from Pennsylvania Transfer
Inheritance Tax on the transfer of the property
described below:
1. Bureau File #
21 78 80
2. Date of Death __ F~br:uJlr.L~1978__
3. Date of Approval ) d.v ..J~) I Ii " (
<. W r
Edna . Newcomer
4. Name of Decedent
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 360.00 *
(Note: Where the property is other thon 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 percenta9" amount above). * 15 shares National Central Financial Corporation
at 24
6. Check the manner in which the transfer was effected and submit a copy of the document authoriz.ing the transfer, unless
such material has been previously filed.
WILL /J.;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organiz.ation receiving property:
NAME Lutheran Church Women's Organization, St. Paul's Lutheran Church
ADDRESS
New Cumberland, Pennsylvania
8. I certify that the information contained herein is, to the best of my knowledge and belief, true and correct.
Signature of Applica.nt,7//, --;"
'33/16'th ~t:'t<"'~-' o. . <-
Add f A I. t New Cumberland, Pa.
ress 0 pp Icon
~>f!1 C;;:~~7t<7?=':~j
402 Pleasantview Road
New Cumberland, Pa.
Official Title
Coexecutors
Date
May 1, 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 alt three copies to the Director, Bureau of County Collections,
Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Po.
00 not write below this line M For Official Use Only
Approved: For the Secretary of Revenue
Referred to Bureau Headquarters
Approved 0
For Secretary of Revenue
Denied' 0
)~j,g,~"ItufJln~Mtgister of Will )
'Im OF WiltS
,- ,/1 Cljl.i~HY
"
(Initials of Register of Wills)
(Authorized Signature)
(County)
tr)"J
(County)
(Title)
~\
(Date of Approvdl')
/(f ,1\.
(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 occordance with the provisions of applicable
Pennsylvania Inheritance and Estate Tax Acts.