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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)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
Application is hereby filed for the approval 1. Bureau File # 21-78-136
of an exemption from Pennsylvania Transfer 2. Date of Death March 2, 1978
Inheritance Tax on the transfer of the property -f"r? t4.v
described below: 3. Date of Approval 8 Ink'
, ,
4. Name of Decedent Irene D. Piper
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 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 IX;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, exploin)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME The First United Presbyterian Church
ADDRESS Big Spring Avenue, Newville, PA 17241
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.
Signature of Appl ic
~-
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~, .
. \
Address of Apphcant
1 W. Hi h St.
Carlisle
PA 17013
Officio I Title
Attorney
Date M"y " 1Q78
This form must be completed in triplicate and all three capies delivered ta 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 011 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
(Signature of Register of Wil
"';i.i'?j"(gOIl
,\ V.'I f~
(C ,J Co;;:;;I1T
ounty)
l"7ay of ICht
(Date of Approval)
(lnitiols of Register of Wills)
(Authori zed Signature)
(County)
(Title)
(Dote of Referral)
(Dote of Action)
* See reverse side for reasons
MUST BE FILED IN TRIPLICATE
This section will be campi eted by Bureau Headquarters only when the application for exemption has been denied.
Dote:
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.