HomeMy WebLinkAbout10-09-81 (5)
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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)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
Application is hereby Hied for the approval
of an exemption from Pennsylvania Transfer
Inheritance Tax on the transfer of the property
described below:
1. Bureau Fi Ie # 21 78 -1 21
2. Date of Death @;Zl5'f~~~fl
3. Dote of Approva I
4. Name of Decedent Jacob H. Hiller . Sr.
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $1, 2sn on
(Note: Where the property is other than a specified amaunt 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 percentag..e 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 IJ..;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
ADDRESS
Stone Hill Cemetery, St. Paul Evangelical Lutheran Church r.emetery A~~oci~tion
6839 Wertzville Road, Enola, Pennsylvania 17025
NAME
D 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.
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/ herald K. ~1orrJ6on
Signature of Applicant
Address of Applicant
Center Square. New Bloomfielo, PA
Official Title
Executor
Date
October
q
, 1 q81
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 - 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)
a ~untr) .
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(Date of Appr/val)
(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.
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