HomeMy WebLinkAbout10-09-81 (3)
RCC.3 (4~73)
APPLICATION FOR CHARITABLE EXEMPTION
FROM PENNSYLVANIA TRANSFER INHERITANCE TAX
(Act of Moy 28, 1956, P.L. 1757, and Act of June 15, 1961,
P.L. 373, as amended)
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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 Fi Ie #
71.7R 121
2. Date 01 Death
&>>~V~f/
.Jacoh H. Miller, Sr.
3. Date of Approval
4. Name of Decedent
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $1.250.00
(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 coses 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 percentage 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 0;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(II other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME
Tressler Lutheran Home for Children
ADDRESS
2331 Market Street, Camp Hill, Pennsylvania 17011
D See listing on reverse side for additional charitable organizotions covered.
8. I certify that the information contained herein is, to the best of my knowledge and belief, true and correct.
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Signature of Appl icant
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Address 01 Applicant
Center Square, New Bloomfield, Pennsylvania
Of/iciol Title
Executor
Date
October C( ,lgSl
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 nat 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, Pa.
Do not write below this line. For Official Use Only
For the Secretary of Revenue REFERRED to Bureau Headquarters
Approved 0
For Secretary of Revenue
Denied* 0
!l( ~~ Re~te,al Wills)
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(Date 01 Approval)
(Initials 01 Register 01 Wills)
(Authorized Signature)
(County)
(Title)
(Date 01 Relerral)
(Date 01 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.
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