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HomeMy WebLinkAbout10-09-81 (4) 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 15, 1961, P. L. 373, as amended) i~. ".. i<- ~ 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 # 21-78-121 2. Date of Death d01~)-~hf/-- Jacob H. Hiller. Sr. 3. Date of Approvol 4. Name of Decedent 5. The Commonwealth's appraised value of the property for which an exemption is claimed is $1 r 250.00 (Note: Where the property is other than a specified amount of cash, the exemption cannot be approved unti I 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 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 llJ; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (If other, exploin) 7. Correct Business Name and Address of Charitable Organization receiving property: Elizabethtown Hospital foy Children Ii Youth ADDRESS Elizahethtown, Pennsylvania 170220710 o See listing on reverse side for additional charitable organizations covered. 8. I certify that the information contained herein is, to t~e best of my knowledge and belief, true and correct. C/ NAME Signature of Applicant ~-- - l. ' L.." L.~--_____ ('._~ _L- ~< _ Address of Applicant Center Square, New Bloomfield, Pennsylvania Official Title Executor Date October ,'/ . 1981 This farm 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 nan.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. For Official Use Only APPROVED: For the Secretary of Revenue REFERRED to Bureau Headquarters Approved 0 For Secretary of Revenue Denied* 0 (Initials of Register of Wills) (Authori zed Si gnatu re) (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. ,.....' ~, a 0, " ~O c::. I '--..;;:: l.L~1 ;:1.: ai- 0::(/ , C '.-t.... to Ot_-~I :;<;;::..if ULl,..! 53 ~a::: ~ ~ ~<-; ,..) 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 15,1961, P. L. 373, as amended) i~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is hereby filed for the approval of on exemption from Pennsylvania Transfer Inheritance Tax on the transfer of the property described below: 1. Bureau Fi Ie II NO, 7] -7R-17l 2. Date of Death :fb~t:J~ .1;7)7/---- 3. Date of Approval 4. Name of Deceden t 5. The Commonwealth's appraised value of the property for which an exemption is claimed is $1, 7r;O nn (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 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 1l; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (If ather, explain) 7. Correct Business Name and Address of Charitable Organization receiving property: NAME St. Paul Evangelical Lutheran ~hurch ADDRESS 7839 Wertzville Road, Enola, PA 17025 o See listing on reverse side for additional charitable organizations covered. 8. I certify that the information contained herein is, to the best of my knowledge and belief, true and correct. -'~A' iJ//;' .f!' fLL IC",--~___________ Signature of Applicant ----=c:- ,. ,'0<<- {Ll.:Z .- Gerald K. Morrison Address of Applicant Center Square, New Bloomfield, PA Official Title Execntor Date / nrt-nhpr t.( 1 QRl 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. 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 (Initials of Register of Wills) (Authorized Signature) (County) (Title) (Date of Referral) (Date of Action) * See reverse side for reasons MUST BE FILEO IN TRIPLlCA TE 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. .- .- CV'- .-., 0.. .. : 0, C I <OO.i '-1. , low 1_1 .:::::0.:.-. 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