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RCC-3 ~\-6'7)
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)
~~-
~
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
:;,UREAU OF COUNTY COLLECTIONS
Application is hereby filed for the approval of an exemption from Pennsylvania Transfer Inheritance Tex on the transfer of
the property described below:
1. Estate of
William B. Clippinger
of Shippensburg, Cumberland
County
2. County File #
21-78-97
3. Bureau Fi Ie #
4. Date of Death 10/11/77
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 500.00
(Note: Where the property is other than a specified amount of cosh, 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 th. gift
or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those ca.es
enter such fractional or percentage amount above).
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 6Z;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
ADDRESS
Christian & Missionary Alliance Church
117 East Orange Street, Shippensburg, Pa.
NAME
?
8. I certify that the information contained here' ~'is, to the best of,,"y knowledge an
Signature of Applicant
(I
-v
Address of Applicant
24 West King Street, Shippensburg, Pa. 17257
Attorney for Executors
Date
November J 1
, 1978
Official Title
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 Penn.ylvania and
letters were not issued by 0 Pennsylvania Register of Wills, deliver 011 three copies to the Director, Bureau of County Collections,
Penna. Deportment of Revenue, 26 S. 4th Street, Harrisburg, Po.
00 not write below this line - For Official Use Only
Approved: For the Sec:retary of Revenue
Referred to Bureau Headquarters
Approved 0
For Secretary of Revenue
Oenied* 0
(Initials of Register of Wills)
(Authorized Signature)
L:C_-(Eounty)
(County)
(Title)
(Date of Approval)
(Date of Referral)
(Date of Action)
* See reverse side for reasons
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 den1ed 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.
RCC-3 ('i-67)
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
OEPARTMENT OF REVENUE
?,UREAU 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. Estate 01
William B. Clippmqer
01
~hippens.l.:urq I Cumberland
County
2. County File # 21-78-97
3. Bureau File :I
4. Date 01 Death 10/11/77
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 500.00
(Note: Where the property is other than a specified amount af 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 cales
enter such fractional or percentage amount above).
6. Check the manner in which the transfer was effected and submit a copy of the document authori:ring the transfer, unless
such material has been previously filed.
WILL G;
DEED 0;
TRUST INDENTuRE 0;
SURVIVORSHIP 0;
OTHER 0;
(II ather, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME
Prince Street United Brethren Church
ADDRESS
N. Prince Streetr Shippensburg, Penna. 17257
Signature of Applicant
lief, true and correct.
8.
certify that the information contained herein is
the Estate of William B.
Address 01 Applicant
24 West Kinq StreE."t, Shippensburq. Pa. 17257
Official Title
Attorney for E~ecutors
Date
November 1'1
. 1978
This form must be completed in triplicate and all three copieil 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 estote. 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. Deportment of Revenue, 26 S. 4th Street, Harrisburg, Po.
00 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
Denied* 0
1
(Signature of Register of Wil ~
" ~
(Initials 01 Register 01 Wills)
(Authorized Signature)
.,
(County)
(Title)
(County)
C)70VaJIQ1!
(Date 01 Approval)
(Date 01 Relerral)
(Date 01 Action)
* See reverse side for reasons
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 Tox Acts.