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APPLICATION FOR CHARI fABLE 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 PEt-lt-lSYLVANIA
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 #
21-78-127
2. Date of Death _~b~~"~U78__
3. Date of Approval
4. Name of Decedent Edward L. Ryan
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 8,834.92
(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 1$;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME The Methodist Childrens' Home - Shiremanstown. Pa. 10%
ADDRESS 900 South Arlington Avenue, Harrisburg, Pennsylvania 17109
I!J 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.
cem B?, N.A., Ex~utor ~of Estate of Edward L. Ryan
Signature of Applicant By' I~ f!J1"J / (2' (, 1JU!J1J~)
,
P.O. ~ 308, CamP Hill, Pennsylvania 17011
Address of Applicant
Official Title
Trust Officer
Date
June 29 1979
This form must be completed in triplicate and all three capies 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, Pa.
Do not write below this line - For Official Use Only
REFERRED to Bureau Headquarters
Approved 0
For Secretary of Revenue
Denied* 0
(Signature of Register of Wills)
(Initials of Register of Wills)
(Authori zed Signature)
r,I'.
,
" ' - ,,-,~
(County)
(_-,_;;"'f
(County)
(Title)
(Dote of Approval)
(Dote of Referral)
(Date of Action)
* See reverse side for reasons
Je,./j
/.?, /'j77
MUST BE FILED IN TRIPLICATE
This section will be com I eted b Bureau Head uarters onl when the a lication for exem tion 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.
The Camp Hill Methodist Church
417 South 22nd. Street, Camp Hill, Pa. 17011
20%
The Holy Spirit Hospital
North TWenty-first Street, Camp Hill, Pa. 17011
20%
D. W. Seidel Memorial Hospital
Filbert & Simpson Streets. ~~chanicsburg, Pa. 17055
20%